STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
PUNTA GORDA HMA, INC., licensee )
for Charlotte Regional Medical ) Center, )
)
Petitioner, )
)
vs. ) Case No. 98-1134
)
AGENCY FOR HEALTH CARE ) ADMINISTRATION and BON SECOURS- ) VENICE HEALTH CARE CORPORATION, )
)
Respondents. )
) SARASOTA COUNTY PUBLIC HOSPITAL ) BOARD, d/b/a SARASOTA MEMORIAL ) HOSPITAL, )
)
Petitioner, )
)
vs. ) Case No. 98-1142
)
AGENCY FOR HEALTH CARE ) ADMINISTRATION and BON SECOURS- ) VENICE HEALTH CARE CORPORATION, )
)
Respondents. )
) SARASOTA DOCTORS HOSPITAL, INC., ) d/b/a COLUMBIA DOCTOR'S HOSPITAL ) OF SARASOTA, )
)
Petitioner, )
)
vs. ) Case No. 98-1145
)
AGENCY FOR HEALTH CARE ) ADMINISTRATION and BON SECOURS- ) VENICE HEALTH CARE CORPORATION, )
)
Respondents, )
and )
) Naples COMMUNITY HOSPITAL, INC., )
)
Intervenor. )
BON SECOURS-VENICE HEALTH CARE ) CORPORATION, )
)
Petitioner, )
)
vs. ) Case No. 98-1497
)
AGENCY FOR HEALTH CARE )
ADMINISTRATION, )
)
Respondent. )
) PUNTA GORDA HMA, INC., licensee )
for Charlotte Regional Medical ) Center, )
)
Petitioner, )
)
vs. ) Case No. 98-3420RX
)
AGENCY FOR HEALTH CARE )
ADMINISTRATION, )
)
Respondent. )
)
RECOMMENDED ORDER
These consolidated cases were heard by David M. Maloney, Administrative Law Judge of the Division of Administrative Hearings, from February 23, 1999 through March 16, 1999, with a final day of hearing on March 18, 1999, in Tallahassee, Florida. A separate Final Order has been issued in Case No. 98-3420RX.
APPEARANCES
For Punta Gorda HMA, Inc., licensee for Charlotte Regional Medical Center:
James C. Hauser, Esquire Skelding, Labasky, Corry, Hauser,
Jolly & Metz, P.A. Post Office Box 669
Tallahassee, Florida 32302-0669
For Sarasota County Public Hospital Board, d/b/a Sarasota Memorial Hospital:
Robert A. Weiss, Esquire Karen A. Putnal, Esquire
Parker, Hudson, Rainer & Dobbs, LLP The Perkins House, Suite 200
118 North Gadsden Street Tallahassee, Florida 32301
For Sarasota Doctors Hospital, Inc., d/b/a Columbia Doctor's Hospital of Sarasota:
John D.C. Newton, II, Esquire Berger, Davis & Singerman, P.A.
215 South Monroe Street, Suite 705 Tallahassee, Florida 32301
For Agency for Health Care Administration: Richard A. Patterson, Esquire
Agency for Health Care Administration Post Office Box 14229
Tallahassee, Florida 32317-4229
For Bon Secours-Venice Health Care Corporation: Frank P. Ranier, Esquire
Gerald B. Sternstein, Esquire Sternstein, Rainer & Clarke, P.A.
314 North Calhoun Street Tallahassee, Florida 32301-7606
For Naples Community Hospital, Inc.:
W. David Watkins, Esquire Deborah LaCombe, Esquire
Watkins, Tomasello & Caleen, P.A. Post Office Box 15828 Tallahassee, Florida 32317-5828
STATEMENT OF THE ISSUE
Whether either, both, or neither of the applications by Sarasota Doctors Hospital, Inc., and Bon Secours-Venice Health Care Corporation for an open heart surgery program in District 8 should be approved?
PRELIMINARY STATEMENT
On March 5, 1998, the Division of Administrative Hearings received a notice from the Agency for Health Care Administration ("AHCA" or the "Agency"). The notice advised that a request for formal hearing had been filed with AHCA by Punta Gorda HMA, Inc., the licensee for Charlotte Regional Medical Center ("CRMC"). The request was in the form of a petition entitled "Petition for Formal Administrative Hearing" filed by CRMC. The petition challenged AHCA's preliminary approval of CON 8914 to Bon Secours-Venice Hospital ("Venice") to establish an adult open heart surgery program. The petition was assigned Case No. 98- 1134 by the Division of Administrative Hearings.
Sarasota County Public Hospital Board, d/b/a Sarasota Memorial Hospital ("Sarasota Memorial") and Sarasota Doctors Hospital, Inc., d/b/a Columbia Doctor's Hospital of Sarasota ("Doctors") also filed petitions for formal administrative proceeding with the Agency. Just as the petition of CRMC, Sarasota Memorial's petition contested the preliminary approval of Venice's application. It also supported the denial of an application filed by Doctors in the same batching cycle for a new adult open heart surgery program in District 8. Like the two other petitions, Doctors contested the preliminary approval of Venices' application. Unlike the Sarasota Memorial petition, Doctors contested the preliminary denial of its own application.
The two petitions were referred to DOAH by AHCA at the same time as CRMC's petition. Sarasota Memorial's petition was assigned Case No. 98-1142; Sarasota Doctors was assigned Case No. 98-1145.
On March 20, 1997, DOAH received a notice from AHCA of another petition, this one filed by Venice. Entitled "Approved Applicant's Petition Challenging Other Specified Co-Batched Applications," the petition requested a hearing, consolidation with Case Nos. 98-1134, 98-1142, and 98-1145, and the ultimate relief that Venice's application be finally approved together with final denial of the petitions of Sarasota Doctors.
Case Nos. 98-1134, 98-1142, and 98-1145 were consolidated pursuant to a notice of related petitions. Case No. 98-1497 was also consolidated with the three other consolidated cases, and the undersigned was designated as the administrative law judge to conduct the proceedings on the consolidated cases.
On July 27, 1998, CRMC filed a petition with the Division of Administrative Hearings a petition seeking a determination that a portion of Rule 59C-1.033, Florida Administrative Code, is invalid. The case (the "Rule Challenge") was assigned Case No.
98-3420RX and consolidated with the other four proceedings pursuant to an order ruling on a motion to consolidate by CRMC.
In the interim, Naples Community Hospital ("Naples") filed a petition to intervene in consolidated Case Nos. 98-1134, 98-1142, and 98-1145. The petition requested that Doctors' application
for CON 8913 be finally denied. Intervention was granted subject to proof of standing at final hearing. Naples did not seek to intervene in the Rule Challenge and continues to take no position on the challenge with the filing of its proposed recommended order. Its purpose in intervening in this proceeding is to oppose the application of Doctors. It does not oppose the application of Venice.
Final hearing spanned four weeks; the hearing commenced February 23, 1999 and ended March 18, 1999. Doctors proceeded first. It presented the testimony of William C. Lievense, an expert in hospital administration; Nora Lissy; Shirley A. Spicer, an expert in risk management and quality management; Robert Irwin Goodman, an expert in health insurance including managed care plans; Gail Arlene Harrison, an expert in nursing administration and hospital administration; and Ronald T. Luke, an expert in the fields of health planning, health policy, and health economics.
Doctors offered exhibits into evidence marked for identification as Doctors' Exhibit Nos. 1 through 9, 11A-11K, 12, 13, 14A-14K,
15-20, 22-38, 40-42, 44-52, 56-60, 64-67, 69, and Rebuttal 1 and
Of these, all were admitted into evidence in their entirety with the exception of Doctors' Exhibit Nos. 34, 35, and 47 which were rejected and Doctors' Exhibit No. 38 which was admitted in part.
Venice proceeded next. It called as witnesses Sister Mary Catherine Rodgers; Gary Hrbek, expert in hospital administration;
Mike W. Cottrell; Ernest J. Peters, expert in traffic engineering and studies; Bryan L. Smith, M.D., expert in physician medical staffing issues; William J. Corin, M.D., expert in cardiology; Michael Basnight, M.D., expert in cardiology and the clinical practice of invasive and interventional cardiology; Gail E. Latimer, expert in nursing and clinical administration of patient care service for hospitals; Donald J. Heinz, expert in hospital financial administration; Michael Harrington, expert in hospital administration; Gene Nelson, expert in health planning; Armand E. Balsano, expert in financial feasibility and health care finance; William P. Graper, M.D., expert in cardiovascular surgery and clinical administration of cardiovascular surgical services; Professor Richard M. Scheffler, expert in health care economics; and Professor Trevor Sheldon, expert in health services research. Venice Exhibit Nos. 1 through 34, 36, 37, 39 through 45, 47, 49
through 61, 63 through 77, 81 through 86, and 90 through 92 were offered into evidence and admitted. Venice Exhibit No. 35 was not offered into evidence although it was marked. Venice Exhibit No. 38 was offered and rejected without prejudice to re-offer it later in the proceeding. It was not offered again. Venice Exhibit No. 48 was offered, rejected, and then proffered. Venice Exhibit No. 62 was offered and rejected. Venice Exhibit No. 78, 79, and 80 were offered, rejected, and proffered. Venice Exhibit Nos. 87 and 88 were admitted on rebuttal. Venice Exhibit No. 89
was rejected and then withdrawn with the understanding that CRMC Exhibit No. 37 would be withdrawn.
Memorial proceeded after Venice. It presented witnesses Michael Covert, expert in health care administration; Margaret Mortensen, expert in cardiovascular services administration and management; Joane Goodroe, expert in cardiovascular nursing, cardiovascular administration, and managed care contracting; Joan Zettinger, expert in administrative and clinical aspects of open heart recovery, cardiac intensive care, and cardiac progressive care; Richard Knapp, expert in health care finance; William Colgate, M.D., expert in emergency medicine and emergency medicine administration; and Mark Richardson, expert in health care planning. Memorial Exhibit Nos. 1 through 22 were all admitted into evidence.
Naples presented the testimony of Michael Jernigan, expert in health care planning; Kandis Frank, expert in managed care; and John Wiest, expert in hospital finance. In lieu of live testimony, Naples introduced transcripts of the depositions of William Crone, expert in hospital administration, and Edward Morton, expert in hospital finance. Naples Exhibit Nos. 6c, 20, 23a, 23b, 23c, 24a, 24b, 24c, 24d, 26a-f and 27 were offered and admitted into evidence. Naples Exhibit No. 3 was offered, ruled inadmissible, and proffered. Naples Exhibit No. 19A was marked for identification but not offered. Naples Exhibit No. 22 was offered but withdrawn following objection and a stipulation of
the parties. At the request of Naples, official recognition was taken of the Friday, June 26, 1998/Rules and Regulations publication of the Federal Register, pages 34968 through 35016.
CRMC was the last of the non-governmental parties to proceed. It presented the testimony of Peggy Greene, expert in nursing and nursing administration; Dan W. McAdams, expert in managed care; and Richard A. Baehr, expert in health care planning and health care finance. CRMC Exhibit Nos. 1 through 23, 26-36, and 39 through 58 were offered and admitted into evidence. CRMC Exhibit Nos. 24 and 25 were offered and withdrawn. CRMC Exhibit No. 37 was offered but withdrawn after Venice agreed to withdraw its Exhibit No. 89.
The Agency proceeded last. It presented the testimony of Elfie Stamm, expert in health planning, CON review, and CON administration. Agency Exhibit Nos. 1 through 3 were admitted into evidence. Without objection, official recognition was taken of Agency Exhibit No. 4.
The time for filing proposed recommended and final orders was extended twice pursuant to agreements of the parties until June 23, 1999. All six parties timely filed proposed orders.
FINDINGS OF FACT
Preliminary Action
Three Certificate of Need Applications were filed in the batching cycle for the July 2000 planning horizon to establish adult open heart surgery programs at hospitals in District 8:
CON 8913 filed by Doctors, CON 8914 by Venice and CON 8915 by Fawcett Memorial Hospital, Inc.
In the January 30, 1998, issue of the Florida Administrative Weekly, Vol. 24, No. 5, Page 569, the Agency noticed its intent to approve Venice's application. In the same publication, the Agency noticed its intent to deny the applications of Doctors and Fawcett.
Preliminary action by the Agency on the Venice and Doctors applications are at issue in this proceeding. No party contests the denial of the Fawcett application.
The Parties
i i. Columbia Doctors Hospital of Sarasota
Sarasota Doctors Hospital, Inc., d/b/a Columbia Doctor's Hospital of Sarasota ("Doctors"), one of the two applicants in this proceeding, is a 168-bed general hospital, with 147 acute care beds and 21 adult substance abuse beds. The substance abuse beds are not in use and the hospital is in the process of de- licensing them. Doctors provides pediatric care, obstetric care, and in-patient cardiac catheterization services as well as a broad range of acute care services, both in-patient and out- patient. It does not provide tertiary health care services.
Doctors is part of Columbia’s national health care system. Included in the system are one hospital in Charlotte County, two hospitals in Sarasota County, three in Lee County, and one in Manatee county. The Columbia hospital in Manatee
County, Blake Memorial, provides open heart surgery ("OHS"). It is about 21 miles north of Doctors.
Doctors is located in the City of Sarasota approximately six miles east of Sarasota Memorial Hospital at Exit 38 of Interstate 75. It moved to this location in January of 1995. Prior to the move, the hospital was in a 28 year-old rundown structure that had been converted from a nursing home. Since moving, occupancy rates have increased. The increase is due, at least in part, to enhanced expectations of admitting physicians that the hospital, now in a more modern facility, has become able to treat patients beset with medical problems of greater complexity than those treated at its prior location.
At the time Doctors filed its application, it enjoyed accreditation "with commendation" from the Joint Commission on Accreditation of Healthcare Organizations ("JCAHO"). It has since lost its commendation. Still, there is no question that Doctors provides a high quality of care to the patients admitted and treated there.
ii. Bon Secours-Venice Hospital
Bon Secours-Venice Hospital is operated by Bon Secours- Venice Corporation ("Venice"), a not-for-profit corporation. Venice is affiliated with Bon Secours Health System, Inc., (the "System"). Also a not-for-profit health care organization, the System includes 15 acute care hospitals, five nursing care centers, one assisted living facility, and other health care-
related services. Among the hospitals in the System is St. Joseph's of Port Charlotte. The System operates strategically to strengthen its individual members. It is reasonable to expect that St. Joseph's, not having an OHS program itself, will refer OHS patients to Venice, if Venice's application is approved.
Venice’s Vice-President for Mission, Sister Mary Catherine Rogers, is a member of the Roman Catholic Order of the Sisters of Bon Secours. Founded in Paris in 1824 to care for the sick in their homes, the Order opened its first hospital in the United States in 1919. The operating principles of the Bon Secours Health System are established in accordance with the mission of the Sisters of Bon Secours. Indeed the System itself is rooted in that mission, fairly summarized in Sister Mary Catherine’s view at p. 6 of Venice’s Omissions Response:
Our Mission is to provide health care services to those in need, especially to the poor and dying, for the purpose of alleviating human suffering and affirming human meaning in the midst of pain and loss.
(Venice Ex. 2, p. 6). As the Vice-President of Mission for Venice, it is Sister Mary Catherine’s job to:
bring the mission . . ., which is really the mission of the Roman Catholic Church, into focus . . . where decisions . . . and policies and procedures are made and future planning is done . . . [at the administrative level of Bons Secours-Venice Hospital].
(Tr. 774).
Bon Secours-Venice Hospital is a general hospital located in South Sarasota County about 17 miles from Sarasota
Memorial. It has 342 beds, consisting of 276 general acute care beds, 30 adult inpatient psychiatric beds, and 36 skilled nursing beds. It has an active cardiology program that provides a range of non-invasive, diagnostic, and therapeutic cardiology services. These include in-patient and out-patient cardiac catheterization, echocardiography, electrophysiology, nuclear cardiology, chest pain observation, pacemaker installation, and emergency care.
Venice also provides cardiology services at out-patient and ambulatory clinics.
iii. Sarasota Memorial Hospital
Sarasota Memorial Hospital is operated by Sarasota County Public Hospital Board ("SCPHB") pursuant to the 1949 legislative mandate that established SCPHB as a special taxing district of Sarasota County. Memorial is located at 1700 South Tamiami Trail in the City of Sarasota, eight miles west of Doctors and 17 miles north of Venice. Its mission is to provide health care services that excel in quality and innovation primarily to the citizens of Sarasota County.
With over 600 physicians on Memorial's medical staff and 853 licensed beds, Memorial provides a full range of in- patient medical and surgical services. Memorial is also a regional referral center for several specialty services, such as high-risk obstetrical care, infertility treatment, minimally- invasive neurosurgery, gastroenterology, and the tertiary services of OHS, and Level II and III neonatal intensive care.
Memorial is accredited system-wide by JCAHO with commendation, and is one of only 15 similarly-sized hospital systems in the United States to achieve system-wide commendation. Memorial's cardiovascular program has earned distinction as a regional cardiac center of excellence, as recognized by additional accreditations by the American College of Nuclear Physicians, and the Intersocietal Commission for Vascular Laboratories. These distinctions, combined with Memorial's national ranking as a high-volume provider of OHS, qualify Memorial to compete for regional and national cardiovascular clinical trials involving experimental or advanced technological and medical protocols in nuclear cardiology, OHS, and percutaneous transluminal coronary angioplasty ("angioplasty").
iv. Charlotte Regional Medical Center
Charlotte Regional Medical Center ("CRMC") is a licensed 208-bed hospital in Punta Gorda, Charlotte County. It provides a full range of general medical and surgical services. About 80 percent of its admissions at CRMC are cardiac-related. CRMC enjoys a national reputation for its cardiac services that involve intervention.
CRMC’s open heart program is comprised of two dedicated operating rooms and a third room for back-up. CRMC has capacity to do at least 1,000 open heart surgeries annually. It has two fully-equipped cardiac cath labs in which angioplasty is provided. CRMC has a dedicated 10-bed cardio-vascular intensive
care unit for post-operative open heart patients, a 16-bed intermediate step-down unit, and a 32-bed telemetry unit.
v. Naples Community Hospital
Naples Community Hospital is a 458-bed general acute care, private not-for-profit hospital system located on two campuses. The main campus is situated in downtown Naples and includes 408 acute care beds. The remaining 50 beds are located at a satellite facility, North Collier Hospital, on Immokalee Road, between Interstate 75 and U.S. 41, in northern Collier County.
In addition to its acute care hospitals, Naples also operates several walk-in emergency centers and clinics throughout the county, including the Isabel Collier Reed Health Center in Immokalee, Florida.
Naples offers a broad range of services, including open heart surgery, traditional family practice medicine, pediatrics, obstetrics, psychiatry, pathology, radiology, oncology, gynecology, neuroscience, internal medicine, neurology, and orthopedics, among others.
Although Naples is the only existing acute care hospital in Collier County, and as such, is the sole provider of hospital services to the indigents of Collier County, it receives no direct financial support from Collier County government to
off-set the cost of providing free services. Nonetheless, during 1996 and 1997, Naples provided over $28 million in charity care
to the residents of Collier County. In 1997 alone, the value of charity, indigent, and subsidized Medicaid care provided by Naples was $19,489,224.
Naples is designated as a "disproportionate share provider" by the Florida Medicaid program, and has been for several years.
Naples is currently accredited "with commendation" by JCAHO.
The status of Naples as the only acute care hospital in Collier County is about to change. Cleveland Clinic-Naples has received final approval to establish a 70-bed acute care hospital at the corner of Pine Ridge Road and Interstate 75 in Collier County. This location is between Naples Community Hospital and North Collier Hospital. The Cleveland Clinic-Naples Hospital will open in the year 2000.
vi. The Agency for Health Care Administration
The Agency for Health Care Administration is "designated as the single state agency to issue . . . or deny certificates of need . . . in accordance with district plans and present and future federal and state statutes." Section 408.034(1), Florida Statutes.
Service Area for Adult Open Heart Surgery Programs
The Service Area applicable in reviewing applications for adult OHS programs is the Service District. Rule 59C- 1.033(2), Florida Administrative Code. Section 408.032(5),
Florida Statutes (1997), provides that AHCA District 8 is comprised of Sarasota, DeSoto, Charlotte, Lee, Glades, Hendry, and Collier Counties.
Although by rule the service area for this proceeding is the entire district, the parties individually presented evidence about and with regard to "primary" or proposed service areas, that is a portion of the service district less than the entire district. Generally, the primary service area is the portion of the service area that a party serves or proposes to mainly serve. For example, Venice describes its primary service area as seven zip codes in southern Sarasota County. About 95 percent of its projected open heart volume is expected by Venice to come from 15 zip codes, four of which are post office box zip codes, all in south Sarasota County. Within this 15 zip code- area is the 7 zip code primary service area designated by Venice.
This approach to service area of designating a portion of the service district as a primary service area or proposed service area less than the entire district was followed by other parties. With respect to Doctors, Memorial's expert witness, for example, looked at Doctors' primary service area as less than Sarasota County. "Doctors' service area in reality is not all of Sarasota County. In fact, looking at patient origin data for Doctors, you find that really Doctors serves the northern portion of Sarasota County." (Tr. 2059). Even the Agency, despite its rule designating the district as the service area, testified as
if an individual hospital's "service area" were less than the entire district. For example, the Agency's Chief of the Certificate of Need/Financial Review Office, testified:
[W]hen you look at the map and you look at the location of the hospitals, it appeared that Bon Secours-Venice Hospital's application met the criteria for improving geographic access, because Venice has a separate service area as compared to Sarasota Memorial and the other hospitals, and compared to Columbia Doctor's Hospital of Sarasota, which shares about . . . 40 percent of the same market share as Sarasota Memorial.
(Tr. 3192, e.s.).
The proposals by both Doctors and Venice to serve primarily one half of one of the counties (northern Sarasota County in the case of Doctors and southern Sarasota County in the case of Venice), is consistent with hospital type. Both are community hospitals and do not have a "tertiary type draw area or referral area." (Tr. 2953).
The Proposed Projects
Doctors proposes to establish an adult open heart surgery program for a cost of $2,923,374.
It represents that it will do so by constructing a new operating room that will meet the standards of OHS, remodel an existing operating room to serve as a back-up OHS room, and establish a new step-down unit. Doctors will model its program and protocols after Southwest Florida Regional Medical Center.
Those procedures have resulted in Southwest Florida having a program with excellent quality.
Venice proposes to construct an OHS program for
$4,958,020 from discretionary capital. The capital to be used as the source of the funding is denominated "discretionary" because the CEO has authority to expend up to $5 million without approval by the Bon Secours Health System's board. "Anything in excess of
$5 million requires both [the CEO's] approval and the Bon Secours Health System board's approval." (Tr. 877). Venice has the ability to finance the project at the amount indicated in the application including necessary cath lab upgrade equipment costs included in Venice's project costs.
Venice's application proposes two dedicated open heart surgery operating rooms and two cardiac cath laboratories. In addition, it will make use of an existing open heart intensive care unit which will be dedicated exclusively to OHS patients.
A Tertiary Health Service in a Growth Market Advanced by Maturing Technology
A "tertiary health service" is defined in Section 408.032(10), Florida Statutes:
health service which, due to its high level of intensity, complexity, specialized or limited applicability, and cost should be limited to, and, concentrated in, a limited number of hospitals to ensure the quality, availability, and cost-effectiveness of such service.
Open heart surgery is very complex surgery. In view of its complexity, the Agency has defined adult open heart surgery as a
tertiary health service by agency rule. See Rule 59C-1.002(43), Florida Administrative Code. As a tertiary service, OHS is a referral service; not every hospital should provide such service.
In keeping with its status as a tertiary service, there was testimony that open heart surgery is best provided at regional centers of excellence. Sarasota Memorial is such a center. Yet it is not the only OHS provider currently within the District. There are four other providers in District 8: CRMC in Charlotte County, Naples in Collier County, Columbia Regional Medical Center and Lee Memorial Hospital and in Lee County. Furthermore, north of Sarasota Memorial is OHS-provider Columbia Blake Medical Center in Manatee County, just over the line between District 8 and District 6, not far from Sarasota Memorial.
Although this number of providers in the District seems at odds with the status of OHS as a tertiary service, the number is consistent with the most recent pattern of approval of open heart surgery programs in the State of Florida. Of ten recent approvals, none were approved because they were needed to relieve physical capacity restraints, to make service available within a two-hour travel time to people who did not have them available, or to provide access for Medicaid or indigent patients.
This pattern of approvals indicates that the State of Florida, through its health planning agency, has not sought to minimize the number of open heart surgery programs as much as one
might expect from their status as tertiary services. This pattern reflects, moreover, that OHS is recognized as a "mature technology [and] widespread procedure." (Tr. 559).
It also relates to a "realization both of the evolution in medical technology and the evolution of the market." (Tr. 558). Indeed, the market for cardiology services is one of rapid growth in Florida. Utilization of open heart services is increasing nationwide. It has increased to the point that "while it is not a service that belongs at every hospital . . . it is
`much less rare than it was back in the mid-70's when a lot of the CON rules relating to open heart surgery were adopted[,]" (Tr. 2912), so that OHS services have become a "very common service in many hospitals." (Id.)
Numeric Need in District 8
Pursuant to the formula for calculating need contained in Rule 59C-1.033(7), Florida Administrative Code, AHCA calculated that a fixed need of one adult OHS program for the January 2000 Planning Horizon existed in District 8. The need projection was published in Florida Administrative Weekly, Vol. 23, No. 32, dated August 8, 1997. The fixed need determination by the Agency went unchallenged.
The Agency's preliminary decision that need exists for an additional OHS program in Sarasota County was based solely on the Agency's calculation of numeric need. It was not based, for example, on problems with access to OHS services or quality in
the delivery of those services. In light of numeric need, award by the agency to Venice was made upon a determination that it was superior to the other two applicants: Doctors and Fawcett. The award is consistent with the expectation that the demonstration of need is generally much easier when indicated by a fixed need pool than if applicants apply on the basis of "not normal circumstances." Nonetheless, numeric need is only one aspect of the process for assessment of actual need for an additional OHS program conducted through the application of statutory and rule criteria.
Statutory and Rule Review Criteria
Need in Relation to Local Health Plan
The District 8 Local Health Plan includes only one factor relating to adult OHS: whether an applicant currently provides more than 300 cardiac catheterization procedures per year. The parties stipulated that both Doctors and Venice meet this criterion.
Section 408.035(1)(b)
The Availability, Quality of Care, Efficiency, Appropriateness, Accessibility, Extent of Utilization, And Adequacy of Existing Health Care Facilities
And Health Services in the Service District
Existing open heart surgery programs are available, adequate, and appropriate to meet the projected demands of District 8 residents in general. OHS programs are spread "north to south" in the district along its four coastal counties of Sarasota, Charlotte, Lee, and Collier. The five OHS providers in
these four counties receive patients from all over the district, including by referral from the inland counties of DeSoto, Hendry, and Glades. The transfer of a patient to receive tertiary services, including OHS, is not unusual. In the cases of Memorial and CRMC, there have not been situations where a patient's care or outcome has been diminished as a result of a transfer. Memorial and CRMC, moreover, have unused capacity and are adequate and available to meet projected demand.
They are also available, adequate, and appropriate to meet the projected demands of Venice's proposed service area, although less so than in relation to the service district. The primary patient for OHS services is 65 years of age or older. The prevalence of coronary disease in South Sarasota County is "extraordinary." (Tr. 1047). This is due, at least in part, to the percentage of residents over 65 years of age, a percentage
higher than in any one county within the district and much higher than in the district as a whole.
In contrast, Northern Sarasota County, the area from which Doctors is expected to draw most of its OHS patients, has less need for additional OHS than south Sarasota County, largely because of the presence of Memorial.
Memorial's existing cardiovascular services program provides a full array of medical and surgical cardiology services for patients with vascular and heart problems, including OHS and PTCA. In 1998 Memorial performed 1,569 OHS cases and
approximately 3,600 to 4,000 cardiac catheterizations. Memorial's high OHS and angioplasty volume and its outstanding quality of care establish Memorial as a leading regional cardiac center, and an example or model program for other cardiac programs across the country.
Memorial's cardiovascular services, facilities, and equipment are state-of-the-art. As a leading regional cardiac center, Memorial offers the Sarasota community access to a range of advanced medical and surgical technologies, including drug therapy, minimally-invasive surgery and the sophisticated services of laser angioplasties, rotablator, and other coronary atherectomy techniques.
Memorial recently completed implementation of a four- year master facility plan which included major renovation, expansion, and upgrading of its cardiovascular facilities and equipment. Two new OHS operating suites were added, resulting in Memorial's current total of six ORs dedicated exclusively to OHS.
Memorial regularly operates four cardiac catheterization labs five days a week. Memorial has a fifth, mixed-use catheterization lab that is currently equipped, but not currently used, for cardiac catheterization. In January 1999 Memorial opened an 18-bed cardiac cath preparatory and recovery suite that permits outpatient cardiac cath patients to remain in the cath lab area for the duration of their treatment, rather
than occupy cardiovascular acute care beds, thereby increasing the efficiency of patient flow.
Memorial has 20 OHS critical care beds that are exclusively dedicated to the immediate post-surgical recovery and critical care of OHS patients, and an additional ten cardiac critical care beds that are staffed appropriately for OHS patients, and has 146 additional telemetry beds available that are also equipped and appropriately staffed for the care and monitoring of OHS patients prior to discharge.
Memorial's cardiovascular services program includes a specialized regional Chest Pain Center, which served approximately 3,600 patients in 1998. The regional Chest Pain Center enables Memorial to rapidly assess and initiate treatment for patients who present at the emergency room with chest pain.
Both Memorial and CRMC have existing unused capacity. Memorial has the current capacity to perform 3,000 open heart surgeries annually, almost twice its 1998 volume. CRMC has the current capacity to perform 1,000 OHS cases annually, more than twice its most recent annual volume.
The anticipated incremental growth in demand for OHS in Sarasota County is 62 additional cases by the year 2000. Twenty- one to 28 of these cases are expected to arise within Venice's proposed service area and only 15 within Doctors'. Existing providers can easily absorb this incremental growth.
At the same time existing providers are available to patients in need of OHS, there are physician access problems. In the case of CRMC, as of March 3, 1998, its Department of Cardiovascular Medicine required that "[a]ll applicants to the [department] must maintain an office and residence within 20 miles of the hospital." (Tr. 2755, Venice Ex. 70). Two physicians located in Venice, Dr. Corin and Dr. Basnight, have experienced delays in scheduling cardiac catheterizations at Memorial. Patient outcomes, however, have not been compromised with regard to Dr. Corin's patients nor has the outcome or quality of care been compromised because of these delays with regard to Dr. Basnight's patients.
Also of concern is geographic accessibility. Pursuant to Rule 59C-1.033(4)(a), Florida Administrative Code, travel time is acknowledged as one of the review criteria. The parties, pursuant to the pre-hearing stipulation agreed:
As to subparagraph (a), it is stipulated that at least 90% of the District 8 population is within a two-hour average travel time to at least one existing adult open heart surgical program in District 8. However, Venice maintains that this factor can still provide a basis for comparison.
There are no major problems with geographic barriers limiting access to open heart surgery services, the majority of which are scheduled rather than conducted on an emergency basis, in Sarasota County. Nonetheless, geographic access would be enhanced by approval of Venice's application.
Venice's application includes distances generated by a computer program known as Arc View. This program is recognized to be accurate and reliable for determining driving distances. The Arc View program establishes that Venice is located 17 miles from Memorial and 29 miles from CRMC. Doctors is located 5.9 miles from Memorial.
The Arc View program calculates that the average resident in Doctors' primary service area drives 5.2 miles to reach an open heart program. The Venice residents drive 20.7 miles. If a program is added at Venice, the drive distance for the average resident in Venice's primary service area drops to 9 miles. In contrast, the if a program is added at Doctors' the drive distance for average resident of Doctors' primary service area changes less than a mile.
Approval of Venice's proposal would reduce travel to open heart surgery for some patients and physicians residing in Venice's primary service area by ten to twenty minutes.
Approval of Doctors' proposal, on the other hand, would do little if nothing to reduce travel time for most OHS patients for whom Memorial is not significantly farther away and may even be closer.
For the elderly population, reductions in travel distances and travel times of the magnitude afforded by approval of Venice's application are beneficial. Traveling for the
elderly population from the Venice community to Sarasota or Punta Gorda may be disconcerting, in some cases a hardship.
Expert testimony established that travel is of significant concern to the elderly, and the more lengthy the travel the more of an impediment. From a clinical perspective, whether a patient is elderly or not, the faster a heart attack patient can reach a hospital for treatment the lower the chance of death or lasting infirmity. In the case of a patient in Venice's primary service area demanding emergency open heart surgery, no matter how rare, the addition of an open heart program at Venice has the potential to make a significant difference in outcome.
There are no financial barriers to access to existing OHS services in District 8. Memorial is the "safety net" provider of health care services in Sarasota County, providing care to all residents, regardless of ability to pay. The parties stipulated that access to OHS services by Medicaid or indigent patients is not a material issue in this case.
Existing providers of OHS programs in District 8 provide quality of care. The quality of cardiovascular care at Memorial is excellent. CRMC provides high quality of care in its OHS program.
Section 408.035(1)(c), F.S. Ability of Applicants to Provide Quality of Care
It was stipulated that both applicants have established records of providing quality of care to general acute care
patients. Only the ability of the applicants to provide high quality OHS services is in dispute.
Doctors
Doctors' Capacity to Accommodate an OHS Program. Doctors' daily inpatient census has steadily grown since Doctors opened its new facility in 1995 in part because of the changed perception among physicians that the new facility is better able to handle more complex patients. Doctors' daily in-patient census will continue to grow in the foreseeable future as Doctors continues its successful efforts to increase the number of in- patient admissions at its hospital.
At times, Doctors currently operates over its licensed bed capacity during the busy season. It has had as many as 188 in-patients in the facility for its 147 beds. Asked at hearing about operating in excess of capacity, Mr. Lievense replied,
[B]ut they're not all in beds . . . in the middle of the day . . . you've got people down in the cath labs, . . . in the ORs, you've got them in the PACU, the recovery area . . . scattered all over the hospital. So you can have them . . . moving around like that and they're classified as inpatients, but in terms of the operation of the hospital, we don't look at them as inpatient, we look at them as a patient in process.
(Tr. 116). Since opening its new facility, from time to time, Doctors has had to alert the Emergency Medical Services Office of Sarasota County to divert emergency patients from Doctors because of lack of beds. Because of its current constraints, during the busy season, Doctors will not be able to accommodate the
incremental increase in daily census of 14 patients that is associated with implementation of an OHS program at Doctors, without operating in excess of its licensed bed capacity, regardless of the efforts of special bed coordinators who attempt to appropriately locate and relocate patients throughout the hospital.
Doctors has 16 ICU beds grouped in two 8-bed pods. It plans to use five of them for the open heart patients. A review of Doctors' census shows that two-thirds of the time during the peak season (January through March), Doctors does not have five beds available for the open heart program. The problem is not limited to the peak season. Doctors has critical care capacity problems "year-wide." (Tr. 2082).
Doctors' capacity constraints seriously compromise Doctors' ability to operate a high quality OHS program. Doctors does not have adequate numbers of OHS critical care beds to ensure its ability to provide high quality postoperative critical care to fresh OHS patients. At times, the five beds reserved for OHS patients might be occupied by both OHS and general ICU patients. At other times, an ICU bed might not be available for an OHS patient and the patient would have to be in another unit. Mixing OHS patients and general ICU patients is not good practice because it increases the exposure of the OHS patients to infection. Doctors' lack of adequate OHS critical care beds
adversely impacts Doctors' ability to provide high quality of care to OHS patients.
Doctors' ability to accommodate an OHS program is also compromised by the absence from Doctors' proposal of plans to construct and equip an additional cath lab, which will be necessary to accommodate the anticipated increase in diagnostic cardiac caths and angioplasties that are associated with an OHS program.
Venice
Venice's staff already has experience with aspects of complex coronary care. For example, members of Venice's nursing staff are qualified in intra-aortic balloon assist operation and the hospital currently utilizes this device in its cardiology program. Furthermore, Venice has experience in linking up with OHS programs through transfers of patients in need of open heart surgery.
As far as taking the first steps within an operational OHS program, however, Venice proposed in its application that "through the projection period in this document" its program would be "managed" by Sarasota Memorial. (Venice Ex. 2, p. 4.) During the projection period, the applicant described this management function proposed to be carried out by Sarasota Memorial:
SMH [Sarasota Memorial] will provide or will be responsible for the following:
Development of quality and utilization review
Establishment of clinical criteria for acuity classification of patients
Development of cardiovascular surgery clinical pathways
Employment and supervision of all
non-physician personnel related to the open heart surgery operating rooms, including the perfusionists involved in the cardiovascular surgery.
Provision of initial training and continuing education for all non-physician cardiovascular service personnel (including BSVH employees involved in pre-op services, and post-op management)
Recommendations for the purchase of equipment and supplies for the operation of the program
Participation in preparation and survey for BSVH's JCAHO certificate for cardiovascular services
In conjunction with BSVH administration, review, modify or develop, as necessary, all operational policies and procedures for cardiovascular surgery services, other than those regarding pricing and structure
Direction of the day-to-day operation of the open heart operating rooms and participation in coordination of other cardiovascular services which include both pre-op and post-op services, including ICU, CCU, and step-down units.
(Id.) Readily apparent from the above-described management function to be carried out by Sarasota Memorial on behalf of Venice is its comprehensive nature.
Venice also claimed in the application that it
has negotiated and developed an agreement with Sarasota Memorial Hosptital (SMH), securing SMH's aid and assistance in the development, implementation, and operation of the proposed BSVH open heart surgery program.
(Id.) Venice did not prove the existence of such an agreement. Indeed, the status of the purported "securing of SMH's aid and assistance" is that the agreement had not come to fruition at the time of hearing. For various reasons, among them concerns of Memorial about a change in its perceived financial position and manpower issues, as of the time of hearing, it was doubtful that Memorial would be able to provide the services listed in paragraph 67 above. Important substantive issues, moreover, such as Venice's payment to Memorial for its services, had not been discussed at the time of final hearing.
Venice's application contains no proposal for a back-up, should the putative arrangement with Memorial fall through, of the services it counted on Memorial to offer. In
this regard, Venice failed to prove that part of its application which proposed the arrangement with Memorial.
Venice offered evidence to make up for this deficiency. To a certain extent, Venice's clinical staff will rely on the consulting and program leadership of Dr. Graper and Heart Surgical Group of Sarasota. Venice plans on implementing the program in specially dedicated facilities. There will be two open heart surgery operating rooms and two dedicated cath labs.
There will be an eight-bed open heart ICU. Likewise, Venice will use its current ambulatory care centers, preoperative and postoperative areas for its cardiology program, and its current telemetry unit in the program. These units all have adequate capacity and are not subject to any limitations from the extra volume anticipated by an open heart program.
Venice membership in the Bon Secours Health System is of benefit. Within the health care system is St. Mary's in Richmond, which has a successful and experienced open heart program. As Venice was preparing its application, its clinical personnel visited St. Mary's. There was a significant amount of collaboration and assistance provided by St. Mary's. St. Mary's has well-developed clinical protocols, criteria, pathways, operational policies and procedures, and other items Venice could utilize in the day-to-day operation of its open heart program. St. Mary's would even be able to share staff and provide training on an interim basis.
Furthermore, arrangements have been made with Naples Community Hospital to provide assistance in training and program implementation. These arrangements were not contemplated, however, in the application, and evidence that these arrangements would be as comprehensive as what was proposed by way of the Sarasota Memorial collaboration was not presented at hearing.
Quite the opposite is the case with regard to physician resources. Venice's chief of medical staff, Dr. Brian L. Smith,
M.D., testified as to the current capability and sufficiency of the hospital in cardiologists, intensivists, nephrologists, general surgery, anesthesia, and pathology. Venice has a medical staff of over 140 physicians in a wide range of primary care and specialty designations, all of whom are board certified.
Venice has a firm commitment from cardiovascular surgeons. Dr. Peter Graper and the Heart Surgerical Group of Sarasota will be the Venice surgical group. His support was unequivocal, strong, and extensive. Dr. Graper made the following statement as to his level of commitment to the Venice program:
Q: It is correct that no decision as of the time your deposition on December 28 had been made by your group as to which physician, current or proposed new physician, would be the on-site surgeon for the proposed open heart program?
A: At the time of the deposition that's correct. I should add to that answer that as the deposition continues that I made a statement that if it was the desire of the hospital and their sole desire, that I would be their resident physician. I would indeed even sell my house, which is only one year old, and move to that community.
He is already on the Venice medical staff as a consulting physician. (T. 986-987, 2258)
Dr. Graper has significant experience in the field of cardiac surgery programs and their clinical aspects. He has helped one program expand its heart program from 50 cases to 550 cases per year, which involved construction of two new operating rooms. He has also been a consultant in starting the program in
Brevard County at Holmes Regional Medical Center in Melbourne. Furthermore, he is a national consultant on the development of clinical care pathways for the care of post-operative open heart surgical patients. He has an active open heart surgery practice at 250 cases a year.
In the preparation of the Venice application,
Dr. Graper was involved on a "regular basis" in the clinical, medical specialties, physical plant, volume, population needs, cardiac surgical service needs, and all of the ancillary medical services sections. In many of the sections of the application, he is responsible for the descriptive and programmatic components.
Heart Surgical Group of Sarasota has developed an agreement with Venice as to their participation in the establishment of the open heart program. This agreement would be a comprehensive agreement for services, from the development of the CON application, to implementation and subsequent operation of the program. However, it is acknowledged at this time; there is not a signed agreement. (T. 2276-2277)
Dr. Graper and Heart Surgical Group of Sarasota are prepared to help Venice in the following aspects of implementing the open heart program: construction and renovation, including operating theaters and modification of ICU; purchasing of equipment within the operating room and ICU; purchasing of supplies; setting up a quality assurance program for the
operating room, patients in the ICU, and throughout the hospital stay; training and ongoing evaluation of personnel in the operating room and ICU; establishment of care tracks throughout the institution, in the ICU, on a step-down unit, and post- discharge; defining eligible members of the medical staff to do various invasive therapeutic cardiology procedures; the timing of when therapeutic intervention procedures can be utilized during the start-up of the open heart surgery program; and monitoring and authorizing therapeutic procedures and acceptance of high risk patients based upon the development of the program's capabilities during the start-up period.
Two of Sarasota County's leading cardiology group practices, South County Heart Center and Heart Center of Sarasota, are interested in assisting Venice with its program. Perfusionist services can be obtained by contract.
Venice has the necessary surgeon resources to implement and operate a high quality open heart program with the current physicians on the medial staff, and with the surgery commitment of the Heart Surgical Group of Sarasota.
Volume/outcome
From the first year of operation through the fifth year, Venice projects volumes to increase each year beginning with 220 and ending with 325. These volumes are reasonable and achievable.
As indicated by the Agency's open heart rule, there is a correlation between patient outcome and volume. Higher volume OHS programs tend to provide better quality of care than lower volume programs. There is no requirement that an adult open heart surgery CON applicant project 350 procedures per year in its application. Nor is there any requirement that a provider actually provide 350 procedures per year. Still, as evidenced by its rule, the Agency assumes that a volume of 350 OHS procedures annually is desirable in order to ensure quality of care. See Rule 59C-1.033, Florida Administrative Code, and the Final Order in Case No. 98-3420RX issued contemporaneously with this Order.
At the time of hearing, there were 15 OHS programs in the state operating below 350 annually. Some of these programs should not have been approved in the Agency's current view although, unlike the approval in this case, "they were generally not approved under the need formula." (Tr. 295).
The American College of Cardiology and the American Heart Association have published 200 to 300 procedures as the standard for the number of procedures to be conducted by an OHS provider annually in order to achieve quality of care. This position reflects the consensus that the relationship between volume and outcome shows that outcomes are likely to suffer when a provider's annual volume falls below 200 per year. Venice's projections for each year exceed the number, 200, for which there appears to be agreement but falls short of the number, 350, which
the Agency has adopted by rule as a dividing line for ensuring high quality of care by an OHS provider.
In contrast to Venice, Doctors projected it would reach
350 OHS procedures annually by its third year of operation. Doctors' projections would be reasonable and achievable were it not that Doctors has physical capacity problems. These problems are likely to prevent Doctors from reaching its projections. If Doctors were to manage to achieve its volume projections, the capacity constraints compromise Doctors' ability to operate a high-quality program. See Findings of Fact Nos. 63 through 65, above.
iv. Section 408.035(1)(d), F.S.
The Availability and Adequacy of Other Health Facilities and Health Services in the Service District
Of the Applicant, Such as Outpatient Care and Ambulatory Or Home Care Services, Which May Serve as Alternatives For the Health Care Facilities and Health Services to Be Proposed by the Applicant
Given its specification of out-patient, ambulatory, or home care services as alternatives to the proposal of the applicant, Section 408.035(1)(d), Florida Statutes, does not appear to apply to this open heart proceeding. To the extent the term "other health care facilities" applies to existing providers of OHS in District 8, Memorial and CRMC currently have sufficient capacity to meet the projected incremental increase in demand of OHS proposed by the applicants. There are no current or reasonably foreseeable quality problems with the existing providers' OHS programs. Nor are there any geographic barriers
to access existing services. The existing providers are available and adequate alternatives to the projects under review.
v. Section 408.035(1)(e), F.S.
Probable Economies and Improvements in Service Which May Be Derived from Operation of Joint, Cooperative, or Shared Health Care Resources
Doctors does not propose to establish any joint or cooperative relationship that would improve service or result in economies of service.
Venice's proposed management relationship with Memorial was not shown to exist.
vi. Section 408.035(1)(f), F.S.
The Need in the Service District of the Applicant for Special Equipment and Services That Are Not Reasonably
and Economically Accessible in the Adjoining Areas
Neither applicant suggested a need in the service district for special equipment or services that are not reasonably and economically accessible in adjoining areas.
Section 408.035(1)(h), F.S.
The Availability of Resources, Including Health Personnel, Management Personnel, and Funds for Capital and Operating Expenditures, for Project Accomplishment and Operation
Internal Resources
The success or failure of an OHS program depends in part on the experience and proficiency of the members of the hospital staff who provide immediate post-operative care.
Doctors and Venice project sufficient staff of appropriate specialists to operate the proposed program. Whether they will be able to recruit such staff members is another matter.
The market for open heart surgery personnel is national more than local. The pool of skilled, experienced OHS
critical-care nurses is limited nationwide.
Despite difficulty in recruiting experience recently by Memorial and CRMC, there is no reason to think that the effect of either an approved Doctors' program or Venice program will differ markedly from the effect of the increasing demand for staff caused by growing utilization of OHS in Southwest Florida or in North America generally.
Proof as to the prospective applications gives Doctors the edge as to these criteria under Section 408.035(1)(h), Florida Statutes. Doctors benefits from the resources of its parent corporation, Columbia/HCA, and its successful recruiting methods. Venice's application, on the other hand, relies on the unproven agreement with Memorial to staff and train its program during the start up period.
Physician Resources
Findings as to Venice's physician resources are in paragraphs 75 to 82 above.
Doctors should be able to obtain the services of a surgical group to conduct OHS at Doctors. Sarasota is an extremely attractive community for cardiologists. Memorial currently has exclusive contract with both open heart surgery groups practicing in Sarasota. The contracts, however, expire annually. The reality is that Doctors, if approved, should be
able to enter contracts with each group. An example of this reality is that representatives of both groups testified that if Doctors were approved they would likely practice OHS there.
Still, Doctors' arrangements with physicians is less well-defined and certain than Venice's.
Venice has the edge under the physician resources part of criteria in Section 408.035(1)(h), Florida Statutes, because of its firm commitment from Dr. Graper's group.
Section 408.035(i), F.S. Immediate and Long-term Financial Feasibility
The parties stipulated that the projects of the two applicants are financially feasible in the short term. Long-term financial feasibility is in dispute.
Doctors' utilization projections are reasonable and achievable only if it overcomes its capacity constraints. Doctors' proposed project is financially feasible in the long term if it achieves its utilization projections. Venice's projected utilization is reasonable and achievable. If anything, Venice's projections are low. If it achieves its projected utilization, its OHS program will be financially feasible in the long term.
Section 408.035(1)(j)
The Special Needs and Circumstances of Health Maintenance Organizations
Neither applicant demonstrated any special needs or circumstance of managed care organizations that would support approval of a new OHS program.
x. Section 408.035(1)(l), F.S.
The Probable Impact of the Proposed Project on the Costs of Providing Health Service Proposed by the Applicant
Upon Consideration of Factors Including, but not Limited to, the Effects of Competition on the Supply of
Health Services Being Proposed and the Improvements or Innovations in the Financing and Delivery of Health Services Which Foster Competition and Service to Promote
Quality Assurance And Cost-effectiveness
Competition in the health care industry is good for health care and for consumers generally. Although both applicants presented cases for the positive affects of competition produced by the approval of their respective applications, this case presents the potential for competition to have negative effects.
Venice premises its case for positive competitive results on data related to charges. Indeed, Venice is likely to be a lower charge provider than any existing program in the district and likely to be lower than Doctors if Doctors were approved. Because the vast majority of payor sources do not pay hospital charges, but some amount less than charges, however, comparison of hospital charges is a poor indicator of cost- efficiency.
While approval of Doctors' application would have greater competitive effect on Sarasota Memorial than approval of Venice's, approval of either applicant would have some negative effects on Memorial. Competition from Venice poses a real possibility of reducing CRMC's annual volume below 350. And approval of Doctors would substantially affect Naples.
Competitive Effects on Memorial
Memorial currently allocates its fixed costs of providing OHS over approximately 1,569 cases per year. Approval of either applicant would result in reallocation of Memorial's fixed costs over substantially fewer cases, reducing Memorial's cost efficiency with respect to the provision OHS. A reduction in OHS volume at this juncture would particularly adversely affect Memorial's cost-efficiency since Memorial has recently invested approximately $15 million in capital improvements to expand and upgrade its regional cardiovascular services program to reflect the state of the art.
Memorial is a premier provider of OHS. It consistently provides excellent quality of care in its cardiovascular program. Quality of care at existing providers will be more difficult to maintain if a new competitior draws essential, skilled personnel away, creating gaps in core staff. Because the available pool of experienced OHS critical care nursing personnel is limited, approval of either applicant would exacerbate the already problematic recruiting of qualified OHS nursing staff for Memorial and CRMC. In short, approval of either applicant will duplicate existing capacity, and present real potential for the compromise of the current high level of quality of care at Memorial.
The financial impact on Memorial will also be a negative effect of the addition of another competitor in Sarasota
County and the district. Sarasota County Public Hospital Board (SCPHB) is authorized to tax residents of Sarasota County for the purpose of establishing inpatient health care services. While SCPHB has authority to impose property taxes up to two mils, the Board historically has minimized the tax burden on County residents by holding the tax rate to not more than .0253 mils.
SCPHB's tax revenues are used almost exclusively to fund Memorial's capital projects and are not used for operating costs or the provision of charity care.
In fiscal year 1997, Memorial basically broke even. In fiscal year 1998, it showed a $10 million loss from operations. Taking into account its 1998 non-operating, investment revenue, Memorial's bottom line for 1998 was a $2 million loss.
Memorial's recent financial distress is attributable to changes in health care reimbursement, primarily the effects of the Balanced Budget Act of 1997, increased managed care contracting and a growth in services with a corresponding increase in expenses. Memorial is particularly affected by the expansion of Medicare managed care because Medicare HMOs receive fewer dollars per individual in Sarasota County than in any other area of the State.
In response to this financial stress, Memorial eliminated 250 management and administrative positions in late
1998. Further losses will likely force the reduction of patient care services and clinical personnel.
Because there is little or no in-migration into Venice's or Doctors' proposed service area for OHS, the great bulk of the applicants' projected cases is one that otherwise would have been performed by Memorial. Expressed in 1997 dollars, the likely reduction in combined OHS and angioplasty volume represents approximately $6.36 million in lost annual net revenue.
Memorial has historically served as the primary provider of charitable health care services in Sarasota County, providing 99% of all charity care received in the county in 1998, 59% of all care rendered to Medicaid patients in the county, and 90% of all care rendered to Medicaid HMO patients in the county.
Only three or four of Memorial's services generate net revenue. Examples of significant community services provided by Memorial that do not generate net revenue are Level II and III neonatal intensive care, pediatric services, Memorial's Community Health Clinic, Memorial's charitable Northport Clinic, and Memorial's charity obstetric service provided through the County Health Department. Memorial also makes substantial contributions to the Sarasota County AIDS Clinic and the county's Pediatric Indigent Care, Hand Surgery Indigent Care, and Oral and Facial Surgery Indigent Care Funds.
Approval of either applicant would impose constraints on Memorial's ability to continue to provide the level of charity care and services it provides currently to Sarasota County residents.
Impact of Venice's Approval on CRMC
Service area overlap and adverse impact analysis conducted by CRMC's expert, accepted as the evidence of greatest weight on the issue, shows that it is very likely that Venice's approval will cause CRMC's annual volume of OHS to drop below
350. (See the Final Order in Case No. 98-3420RX). The presence of a Bon Secours System hospital in Charlotte County, St. Joseph's, and the System's strategy of referring patients to other hospitals within the system helps to create the heavy impact to CRMC of an approval of Venice. Dr. Luke, Doctors' expert health planner, also testified that approval of Venice would in all likelihood reduce CRMC annual OHS procedure volume "below 350 cases for . . . the indefinite future." (Tr. 625).
Impact of Doctors' Approval on Naples
The closest hospital to Naples is Gulf Coast Hospital, located near the city of Fort Myers, in southern Lee County. The closest hospital to Naples that offers open heart surgery is Southwest Florida Regional Medical Center, also located in Fort Myers. Gulf Coast and SWFRMC are owned by Columbia. In addition to Gulf Coast and SWFRMC, Columbia owns a third hospital in Lee County, East Pointe Hospital.
Columbia owns three other hospitals within District 8. They are Fawcett Memorial Hospital in Charlotte County, Englewood Community Hospital in Sarasota County, and, of course, Doctors.
The final approval of the new Cleveland Clinic Hospital in Collier County was made possible in part due to a settlement reached between Columbia/HCA (and its subsidiary, Big Cypress Medical Center, Inc.) and Cleveland Clinic Florida Hospital-Naples. The terms of the settlement agreement resulted in Columbia dropping its CON application for a 100-bed facility in Collier County (which had been preliminarily approved by AHCA) in exchange for a $5 million payment from Cleveland Clinic and other terms and consideration.
Among the other terms of the Columbia/Cleveland Clinic settlement agreement were the following:
5. Cleveland Clinic will permit Big Cypress to include any hospital in Collier County owned or controlled by the Cleveland Clinic in any network or managed care agreement.
And
7. For a period of seven (7) years beginning with the date of the execution of this agreement, the Cleveland Clinic, through its Professional Staff, and/or Columbia HCA Medical Staff members with whom it may contract, shall exclusively utilize the facilities and services of the facilities owned and controlled by Columbia/HCA in Lee County for all non-emergent and elective medical services, including invasive cardiology and open heart surgery that the
Cleveland Clinic is unable to provide at its facilities in either Collier or Broward County.
(Naples Exhibit number 20).
Paragraph 7 of the Columbia/Cleveland Clinic agreement is a "channeling agreement." This provision requires the "channeling" of patients by the Cleveland Clinic out of Collier County and to Lee County Columbia hospitals. Columbia Fawcett Memorial currently engages in channeling patients from Charlotte County to SWFRMC in Lee County. In fact, patient origin data reflect that approximately 11 percent of Charlotte County patients are channeled to SWFRMC. The channeling agreement will result in Naples' loss of a significant number of OHS cases to Columbia.
Although Doctors' and Naples' primary service areas have not overlapped much, the growth of managed care networking in District 8 is likely to alter and expand a hospital's historic primary service area with regard to tertiary services, such as open heart surgery. In other words, hospitals that have not directly competed with one another in the past may find themselves competitors for tertiary-level patients covered under managed care plans in the future.
There is a strong relationship between the Columbia heath care organization and various providers of managed care product lines which have a propensity to contract exclusively with Columbia. For example, Pacificare of Florida, Inc. (an
HMO), contracts with five of the six Columbia hospitals in District 8, and doesn't contract with any other hospital provider within the district. Another example is Health Advantage/One Source, (now doing business as Columbia Care Network) which has contracts with all six Columbia hospitals in the district, but not with any other hospital providers in the district.
Similarly, Humana Health Care Plans also has managed care contracts with the six Columbia facilities in District 8, but not with any other hospital facilities. In all, Mr. Jernigan identified approximately 14 other managed care companies whose practice was to contract for hospital services exclusively with the Columbia hospitals in District 8.
Columbia has a history of aggressive managed care contracting. Indeed, Columbia has established a national managed care contracting entity, CCN, for the purpose of negotiating and entering into managed care contracts, including within District
As a national hospital chain, Columbia hospitals are part of a single "bargaining unit" for managed care contracts. As such, Columbia is able to utilize its combined market power to negotiate contracts.
Columbia's managed care contracting strategies would come into play if Doctors' application were approved. For example, Columbia would implement a managed care "heart carve-out strategy."
A "heart carve-out" is a particular managed care contracting model that has been utilized in different environments across the United States, and involves identifying a subset of diagnostic related groups ("DRGs") and pricing them differently under a managed care arrangement with an insurance company or even directly with an employer, and negotiating a specific set of rates for those DRGs. Currently the model that is most widely accepted across the United States involves a flat rate or a case rate for a particular DRG, and for additional days beyond a pre-determined length of stay, the provider is reimbursed on a per diem basis, depending upon extenuating circumstances. For example, the flat rate for a particular DRG may be negotiated at $18,000, with a length of stay of ten days, and any additional days beyond that are reimbursed at, for example, $800 per day.
The ability of an organization to implement a managed care carve-out model in cardiovascular/thoracic surgery inpatient services is dependent on facility location relative to patient origin. The general driving time limit of a patient non-emergent service should not exceed 60 minutes. Therefore, in order to achieve a regional carve-out model there must be regional access points every 30 to 50 miles. Further, the successful managed care carve-out model will reduce the health insurance premium by ten percent, which may include other service reductions in order to achieve. Therefore, the pricing of the carve out is dependent
on the insurance company's percentage of costs associated with cardiovascular/thoracic surgery claims and their future risk based on current covered lives heart risk factors. Currently, hospitalization is associated with approximately 50 percent of insurance company's costs. To reduce a health insurance premium by ten percent, the overall hospital cost must be reduced by 20 percent in order to achieve the premium reduction goal.
Of the hospital product lines within District 8, the largest is cardiovascular/thoracic surgery. For District 8 in 1997, this product line alone accounted for total charges of
$349,542,632. Moreover, the cardiovascular/thoracic surgery and cardiovascular disease product lines combined represented over a half billion dollars in charges, and 34.5 percent of the total charges within District 8 in 1997. From a managed care contracting perspective, these product lines are key targets for a managed care carve-out strategy within District 8.
In the event Columbia initiated a heart carve-out strategy in District 8, the potential financial impact on Naples from the non-Medicare open heart surgery product line alone would be in excess of $3 million dollars per year.
Since Columbia's only OHS program in District 8 is located at SWFRMC in Lee County, Columbia cannot presently offer OHS "access points" within a 30-50 minute average drive throughout the district. This makes it difficult for Columbia to implement an OHS carve-out strategy in District 8. The approval
of Doctors' OHS program, however, would significantly enhance Columbia's ability to implement a heart carve-out strategy by providing a second access point within the District. More importantly, the geographic location of the Doctors' OHS program would enable Columbia to offer OHS access within a 30-mile radius to most of the District. Columbia would be able to market and enter into OHS carve-out contracts with managed care companies and employers throughout District 8 and regionally. With the approval of the Doctors' program, "Columbia would have a string of heart units . . . all the way from Tampa through Marco Island." (Naples Ex. 26A, p. 11.).
The patient channeling agreement between Columbia and the Cleveland Clinic further increases the likelihood that Columbia will implement an OHS carve-out strategy within District
This is because the Cleveland Clinic has strong brand identification, and the literature reports that some of the most successful heart carve-out programs have a relationship with an academic environment, including high-tech research and strong brand identity. Thus, the Cleveland Clinic/Columbia partnership within the District enhances Columbia's ability to implement a heart carve-out strategy. Indeed, the implementation of such a strategy is a natural step in the evolution of managed care within District 8. One of the particular benefits claimed by Columbia, should Doctors be awarded the OHS CON, is that such
approval would result in more competitive managed care contracting for OHS services.
In order to successfully implement a regional heart carve-out strategy, a hospital system must also be able to offer access points for outpatient services. Within Collier County alone, Columbia offers diagnostic services and walk-in clinic services with primary care. Further, Columbia owns primary care family practice physicians in the Collier County market and offers rehabilitation services. And just north of the Collier/Lee County border, in Bonita Springs (which is a significant access point for Collier County residents), Columbia has a large ambulatory out-patient surgery facility and clinic comprised of 25 to 50 physicians and major diagnostic, surgical, and general ambulatory care services. Columbia's out-patient presence in Collier County and elsewhere throughout the district will also aid in the development of a regional heart carve-out strategy.
Another factor that mitigates in favor of the development of a heart carve-out strategy by Columbia is the high use rate for open heart surgery within the district. District 8's OHS utilization rate, the highest in the state, at 3.9 per 1000, makes it a prime geographic location for heart carve-out contracts.
The heart carve-out model is not a theoretical construct, but rather is a managed care contracting strategy that
has been successfully implemented by hospital systems elsewhere in the United States, oftentimes resulting in significant shifts in OHS volumes between institutions. Due to the existence of the factors identified above, it is reasonable to conclude that a heart carve-out strategy will be implemented by Columbia in District 8 if an OHS program is approved at Doctors. The implementation of a district-wide heart carve-out strategy would have a significant impact on Naples's ability to compete for managed care contracts, and would adversely financially impact Naples.
Naples currently provides a number of community health and education programs free to the users or at a fee that is less than cost. Those programs span a wide range of community health and education programs, from nurses for the Collier County elementary schools to a diabetes education program. In 1997 Naples spent approximately $3.2 million in providing these community programs. These expenditures were in addition to the
$19.5 million in charity, indigent, and subsidized Medicaid care provided by Naples in 1997.
The significant adverse financial impact on Naples resulting from the approval of the Doctors' OHS program would jeopardize Naples's ability to continue to provide community programs and free subsidized medical services at their current levels. At least some of the existing community programs would
have to be eliminated, and there would be a reduction in Naples' ability to provide services to indigent and charity patients.
The development of a regional managed care network by Columbia, in conjunction with the channeling of OHS patients by the Cleveland Clinic, would enable Columbia to develop an OHS/cardiology "Center for Excellence" at SWFRMC. The development of such a program would have a material impact on the volume of OHS cases performed at Naples. The Collier/Lee County area is a particularly tight labor market for nurses and other skilled hospital workers, and significant growth in the SWFRMC heart program, with increased competition for nurses and other skilled labor, would have an adverse impact on the rates Naples would have to pay for labor.
Similarly, a significant reduction in volume would also potentially impair Naples' purchasing contracts (which are based upon volume) for very costly supply items and equipment used to perform open heart surgery. Moreover, a reduction in OHS volume at Naples would result in its fixed costs for provision of the service being spread over fewer cases, with a resulting increase in the fixed (and total) cost per case.
Cost-effectiveness Comparison
Venice presented evidence of cost-effectiveness based upon standard cost per admission for all services. Venice has a cost of $3,792, while Doctors has a cost of $4,371. Between the two applicants, Venice is the more cost efficient.
Section 408.035(m), F.S.
The Costs and Methods of the Proposed Construction, Including the Costs and Methods of Energy Provision and the Availability of Alternative, less Costly, or More
Effective Methods of Construction
The parties stipulated that the proposed costs and methods of construction are reasonable for the scope of the projects proposed.
Section 408.035(1)(n), F.S.
The Applicants Past and Proposed Provision of Health Care Services to Medicaid Patients and the Medically Indigent
The parties stipulated as follows with regard to the criteria of Section 408.035(1)(n), Florida Statutes:
It is stipulated that both Doctors and Venice have historically provided some volume of care to the Medicaid and indigent patient populations.
It is stipulated that service to the Medicaid and indigent patient populations for adult open heart surgical services in District 8 is not material to this proceeding because the demand by these patient groups for adult open heart surgery is minimal.
The first sentence quoted above is somewhat vague. The second sentence is quite clear: the parties regard the issue of proposed service to Medicaid and indigent populations to not be material to the proceeding.
Although Doctors and Venice may have reached the conclusion in preparing the Joint Prehearing Stipulation that the provision of OHS to the needy is not material to this proceeding, both offered evidence with regard to the issue during the final hearing out of caution that the stipulation might be construed in
some way adverse to them. Both applications, moreover, contain Medicaid and charity projections which the applicants decided, despite the stipulation, to attempt to prove.
Doctors committed to provide 2 percent of its open heart surgery and angioplasty discharges to Medicaid and 2 percent to charity. For several years, Doctors had conditions of
2 percent Medicaid and .75 percent charity attached to its cardiac cath CON. It has failed to meet them. This history calls into question Doctors' ability to meet the projections for Medicaid and charity care made in its application.
AHCA data for 1996, 1997, and Doctors' internal data for 1998 demonstrate charity care by Doctors annually of .25 percent, .29 percent, and .23 percent, respectively; that is, less than 3/10ths of one percent each of those three years. In contrast, measuring the percentage of total care that constituted charity care, Venice provided two to three times the percentages provided by Doctors for the same three years. Less than Doctor's projection, Venice's projection as to charity care is 1.5 percent. Between the two applicants, Venice is much more likely to meet its projection for charity care.
Section 408.035(o), F.S.
The Applicant's Past and Proposed Provision of Service That Promote a Continuum of Care in a Multilevel Health Care System
Venice offers a continuum of care in southwest Florida. In addition to the Venice hospital, there is St. Joseph's Hospital, long-term care facilities located in Venice
and Port Charlotte, several ambulatory service centers, a variety of extended care services including home-health care, personal care, hospice, and several assisted living facilities.
As the greatest provider (excluding existing providers of OHS) of cardiac services in the district, measured as MDC-5 volume, open heart surgery would crown the broad range of continuum of care offered by Venice.
From a continuum of care perspective, Doctors enjoys the benefits of being a member of the Columbia network of hospitals. But it does not have long term care facilities or home-health services in the district.
Section 408.035(2)(b), F.S.
That Existing Inpatient Facilities Providing Inpatient Services Similar to Those Proposed
Are Being Used in an Appropriate and Efficient Manner
Existing providers of OHS are currently providing OHS services in an appropriate and efficient manner.
xv. Section 408.035(2)(c), F.S.
In the Case of New Construction or Replacement Construction, for Example, Modernization or Sharing Arrangements,
Have Been Considered and Have been Implemented to the Maximum Extent Practicable
Neither applicant satisfies the criteria of Section 408.035(2)(c), Florida Statutes.
xvi. Section 408.035(2)(d), F.S.
That Patients Will Experience Serious Problems in Obtaining Inpatient Care of the Type Proposed, in the Absence of the Proposed New Service
Patients in District 8 will not experience serious problems in obtaining OHS services in the absence of approval of a new program.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter of these consolidated cases. Sections 120.57(1) and 408.039(5), Florida Statutes.
Whether by intervention or as Petitioners, Naples, Sarasota Memorial, and CRMC meet the standing requirements for existing providers in Section 408.039(5)(c), Florida Statutes.
Agency Position
The Agency maintains its position that Venice's application should be approved and Doctors' denied. Not persuaded that granting one of the two applications creates too weighty negative impacts to existing providers, and viewing unrebutted the presumption of need for one new OHS program in District 8 created by the determination of fixed need, the agency's postion on which of the two applicants should be approved is summarized in its Proposed Recommended Order:
On a comparative basis, while both applicants propose to locate the requested program in Sarasota County, [Venice] improves geographic access and is superior because its location, in Venice, is approximately 17.3 miles from the closest existing open-heart surgery program at [Sarasota Memorial], while [Doctors] is located approximately 5.8 miles from the closest existing open-heart surgery program, also at [Memorial]. [Citations
omitted.] [Venice] is more cost-effective than [Doctors]. [Venice] has a licensed bed complement more than double that of [Doctors'], which contributes to the greater reasonableness of [Venice's] adult open-heart surgery projections. [Citations omitted]. [Venice] is also superior in that its application contained a commitment from a surgical group which [Memorial's] application lacked.
(Co-Respondent AHCA's Proposed Recommended and Final Orders, p. 4).
From the perspective of comparative review alone, the Agency's preliminary decision is supported by the evidence. While Doctors' application has the edge on a few of the review criteria, Venice's application nonetheless is clearly superior. First, granting Doctors' application would pose quality of care issues because of capacity constraints. Were Doctors' the only applicant, this alone, on the strength of the record in this case, would weigh so heavily against Doctors' that denial of its application would be the best course. Second, an open-heart program at Doctors threatens, much more so than the one at Venice, the financial viability of a recently-weakened Sarasota Memorial, the provider of safety net health care services to the indigent: Medicaid and charity patients. Third, Venice's location would enhance timely accessibility that could be life- saving to those few emergency OHS patients in South Sarasota County and would in many cases lessen the stress on elderly patients and families to whom Venice is closer than the other providers.
But this case is not limited to comparative review of the two applications of Venice and Doctors. And while the publication of a fixed need pool produces a rebuttable presumption of need, Ft. Walton Beach Medical Center, Inc. d/b/a Ft. Walton Beach Medical Center v. Agency for Health Care Administration, 18 FALR 3527: that presumption has been rebutted in this case.
The reasons the presumption is rebutted as to Doctors are discussed in paragraph 154 above. For these reasons, Doctors' application should be denied. A balancing of all the CON criteria weighs very heavily in favor of denial of Doctors' application.
Approval of Venice's application is beset with a different difficulty. Rule 59C-1.033(7)(c), Florida Administrative Code, in pertinent part, provides that
[r]egardless of whether need for a new adult open heart surgery program is shown in paragraph (b) above [that is after calculation resulting in net need for one additional adult open heart surgery program in the district], a new adult open heart surgery program will not normally be approved for a district if the approval would reduce the 12 month total at an existing adult open heart surgery program in the district below 350 open heart surgery operations.
(e.s.) The probability based on the best evidence in this record is that approval of Venice's application, at least in the short term, if not for the foreseeable future, would reduce the annual volume of CRMC's open heart surgeries to a number below 350.
Were it not for the first sentence in subparagraph (7)(c) of Rule 59C-1.033, Florida Administrative Code, a close case would exist for whether Venice should be approved. A balancing of the criteria for CON review would be slightly in Venice's favor. But the rule makes clear that Venice's application, confronted with the evidence in this case of the likely impact approval would have on CRMC, should not be approved.
To its credit, Venice did not attempt to prove "not normal circumstances." In light of the threat to CRMC, it would have had to have done so under the clear terms of the rule. The futility of such an attempt is borne out by this record. No factors typically associated with "not normal circumstances" are present. Quite the opposite, in fact, is the case. Physical capacity constraints among existing providers not only do not exist but capacity is ample for growth in demand for OHS services for a considerable time in the future. OHS services are available within a two-hour travel time to the vast majority of people in the district who need them. Medicaid and indigent patients have access to OHS services in District 8.
Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED:
That the Agency for Health Care Administration enter a final order denying both the application of Sarasota Doctors Hospital,
Inc., d/b/a Columbia Doctor's Hospital of Sarasota (CON 8913) and the application of Bon Secours Venice Hospital, (CON 8914).
DONE AND ENTERED this 16th day of September, 1999, in Tallahassee, Leon County, Florida.
DAVID M. MALONEY
Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
(850) 488-9675 SUNCOM 278-9675
Fax Filing (850) 921-6847 www.doah.state.fl.us
Filed with the Clerk of the Division of Administrative Hearings this 16th day of September, 1999.
COPIES FURNISHED:
Richard A. Patterson, Esquire
Agency for Health Care Administration Post Office Box 14229
Tallahassee, Florida 32317-4229
James C. Hauser, Esquire Skelding, Labasky, Corry, Hauser,
Jolly & Metz, P.A. Post Office Box 669
Tallahassee, Florida 32302-0669
Robert A. Weiss, Esquire Karen A. Putnal, Esquire
Parker, Hudson, Rainer & Dobbs, LLP The Perkins House, Suite 200
118 North Gadsden Street Tallahassee, Florida 32301
John D.C. Newton, II, Esquire Berger, Davis & Singerman, P.A.
215 South Monroe Street, Suite 705 Tallahassee, Florida 32301
Frank P. Rainer, Esquire Gerald B. Sternstein, Esquire
Sternstein, Rainer & Clarke, P.A.
314 North Calhoun Street Tallahassee, Florida 32301-7606
W. David Watkins, Esquire Deborah LaCombe, Esquire Watkins, Tomasello & Caleen, P.A. Post Office Box 15828 Tallahassee, Florida 32317-5828
Ruben J. King-Shaw, Jr., Director Agency for Health Care Administration Fort Knox Building 3, Suite 3116
2727 Mahan Drive
Tallahassee, Florida 32308
Julie Gallagher, General Counsel Agency for Health Care Administration Fort Knox Building 3, Suite 3431
2727 Mahan Drive
Tallahassee, Florida 32308
Sam Power, Agency Clerk
Agency for Health Care Administration Fort Knox Building 3, Suite 3431
2727 Mahan Drive
Tallahassee, Florida 32308
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written exceptions within 15 days from the date of this Recommended Order. Any exceptions to this Recommended Order must be filed with the agency that will issue the final order in this case.
| Issue Date | Proceedings |
|---|---|
| Mar. 20, 2000 | (F. Rainer) Directions to the Clerk filed. |
| Mar. 13, 2000 | Second DCA Case No. 2D00-749 filed. |
| Mar. 07, 2000 | Notice of Filing Correction to Style for Notice of Appeal and Certificate of Service filed. |
| Mar. 07, 2000 | Notice of Appeal filed. (filed by: Bon Secours-
Venice Healthcare Corp. ) |
| Feb. 10, 2000 | Final Order filed. |
| Nov. 12, 1999 | Memorial`s Response and Objection to Agency Notice of Ex-Parte Communications (filed via facsimile). |
| Oct. 15, 1999 | Doctors Hospital`s Notice of Withdrawal (filed via facsimile). |
| Sep. 16, 1999 | Case(s): 98-003420 |
| Sep. 16, 1999 | Recommended Order sent out. CASE CLOSED. Hearing held February 23, 1999 through March 16, 1999. |
| Jul. 13, 1999 | Letter to Judge Maloney from John Newton, II (RE: response to copies of law review articles cited in proposed recommended order) filed. |
| Jun. 24, 1999 | Letter to Judge Maloney from J. Newton Re: Enclosing three law review articles sited in the Proposed Recommended Order; (3) Articles filed. |
| Jun. 23, 1999 | (J. Newton) Proposed Recommended Order (For Judge Signature) filed. |
| Jun. 23, 1999 | Naples Community Hospital, Inc.`s Proposed Recommended Order filed. |
| Jun. 23, 1999 | (G. Sternstein, F. Rainer) Proposed Recommended Order (For Judge Signature); Proposed Final Order (For Judge Signature) filed. |
| Jun. 23, 1999 | Sarasota Memorial Hospital`s Proposed Recommended Order filed. |
| Jun. 23, 1999 | Co-Respondent AHCA`s Proposed Recommended and Final Orders; Proposed Final Order of CRMC; Proposed Recommended Order of CRMC filed. |
| Jun. 15, 1999 | Order Granting Extension of Time and Extension of Page Limit sent out. |
| Jun. 14, 1999 | Letter to Judge Maloney from F. Rainer Re: Consent of Naples to Extension of Time to File PRO and to Expand Page Limination (filed via facsimile). |
| Jun. 11, 1999 | (F. Rainer) Motion to Expand Page Limiation on Proposed Recommended Orders; Motion for Extension of Time to File Proposed Recommended Order filed. |
| Jun. 01, 1999 | Correction page of transcript Volume VIII Final Hearing February 26, 1999 - Afternoon session filed. |
| May 24, 1999 | Order Granting Extension of Time sent out. (parties were given an extension of time to file proposed recommended orders until June 16, 1999) |
| May 21, 1999 | (J. Newton) Notice of Naples Position filed. |
| May 21, 1999 | Corrected Cover Page for Transcript Volume VII filed. |
| May 20, 1999 | (J. Newton) Motion to Extend Due Date filed. |
| Apr. 16, 1999 | (Volumes I through XXVIII) Transcript filed. |
| Mar. 26, 1999 | (J. Newton) Errata and signature sheet for deposition filed. |
| Mar. 17, 1999 | Memorandum to Counsel of Record from K. Putnal Re: Surrebuttal witness (filed via facsimile). |
| Feb. 25, 1999 | (K. Putnal) Notice of Taking Telephonic Deposition Duces Tecum (filed via facsimile). |
| Feb. 23, 1999 | (Naples Community Hospital, Inc.) Notice of Related Cases (Civil and Administrative) rec`d |
| Feb. 22, 1999 | Sarasota Memorial Hospital`s Motion to Quash Subpoena rec`d |
| Feb. 22, 1999 | Sarasota Memorial Hospital`s Motion to Strike Doctors` February 22, 1999 Notice of Filing rec`d |
| Feb. 22, 1999 | Order sent out. (ruling on motions) |
| Feb. 22, 1999 | (J. Newton, II) Notice of Filing; Letter of 2/20/99 to B. Weiss; Letter to 2/21/99 to B. Weiss rec`d |
| Feb. 22, 1999 | Order sent out. (ruling on motions) |
| Feb. 19, 1999 | CASE STATUS: Hearing Held. |
| Feb. 19, 1999 | Joint Response in Opposition to Venice`s Motion to Reconsider Adding Witness; Joinder of Venice in Doctors` Notice of Filing and Notice of Rebuttal Witness rec`d |
| Feb. 18, 1999 | CRMC`s Notice of Motion Hearing rec`d |
| Feb. 18, 1999 | (Naples) Notice of Hearing (filed via facsimile). |
| Feb. 18, 1999 | Letter to Judge Maloney from F. Rainer Re: Enclosing matters Venice would like heard tomorrow with any response to those matters filed. |
| Feb. 18, 1999 | (J. Hauser, W. Watkins) Prehearing Stipulation; Venice`s Response to CRMC`s Motion to Exclude Introduction Into Evidence of Venice Exhibits filed. |
| Feb. 18, 1999 | (J. Newton) Response to Sarasota Hospital`s Motion for Protective Order and Motion in Limine; Bon Secours-Venice Hospital, Inc.`s Motion to Reconsider Adding Witness rec`d |
| Feb. 17, 1999 | Naples Community Hospital, Inc.`s Response to Joint Motion in Limine to Restrict Intervenor`s Participation in Final Hearing (filed via facsimile). |
| Feb. 17, 1999 | Doctors` Notice of Filing; cc: Deposition of James Jollis dated 1/22/99; Article titled Volume and Outcome in Coronary Artery Bypass Graft Surgery: True Association or Artefact rec`d |
| Feb. 17, 1999 | (J. Newton) Notice of Hearing (filed via facsimile). |
| Feb. 16, 1999 | Sarasota Memorial Hospital`s Second Motion in Limine with cover letter rec`d |
| Feb. 16, 1999 | Motion of Bon Secours and Doctors to Extend Deadline for Filing Prehearing Stipulation (filed via facsimile). |
| Feb. 15, 1999 | CRMC`s Motion to Exclude Introduction Into Evidence of Venice Exhibits rec`d |
| Feb. 15, 1999 | (W. Watkins) Response to Sarasota Doctors Motion for Recommended Order Awarding Attorney`s Fees and Costs and/or For Sanctions, and NCH`s Motion for Award of Fees Against Sarasota Doctors rec`d |
| Feb. 12, 1999 | Amended Pre-Hearing Order sent out. (hearing set for Feb. 19 - March 12, 1999) |
| Feb. 12, 1999 | (Naples) Response in Opposition to Sarasota Doctors Hospital`s Motion for Summary Recommended Order rec`d |
| Feb. 12, 1999 | CRMC`s Petition to Intervene to Oppose Columbia`s Con Application rec`d |
| Feb. 11, 1999 | Order sent out. (re: rulings from 2/10/99 telephonic motion hearing) |
| Feb. 10, 1999 | Two Sealed Reports, given to the Judge at hearing filed. |
| Feb. 10, 1999 | (K. Putnal) Request for Oral Argument on Sarasota Memorial`s Motion for Protective Order to Enforce Supplemental Pre-Hearing Order and Motion in Limine Regarding Doctors rec`d |
| Feb. 10, 1999 | (K. Putnal) Request for Oral Argument on Joint Motion in Limine to Restrict Intervenor`s Participation in Final Hearing rec`d |
| Feb. 10, 1999 | Sarasota Memorial Hospital`s Motion for Protective Order to Enforce Supplemental Pre-Hearing Order and Motion in Limine rec`d |
| Feb. 10, 1999 | Joint Motion in Limine to Restrict Intervenor`s Participation in Final Hearing rec`d |
| Feb. 10, 1999 | (J. Newton) Motion for Recommended Order Awarding Attorney`s Fees and Costs and/or for Sanctions rec`d |
| Feb. 09, 1999 | Naples Community Hospital`s Response to Doctors Hospital`s Emergency Motion to Dismiss Petition of NCH or to Exclude NCH From Introducing Evidence rec`d |
| Feb. 09, 1999 | CRMC`s Response in Support of Columbia`s Motion to Depose Naples Witnesses rec`d |
| Feb. 09, 1999 | Joint Response of Memorial and CRMC in Opposition to Venice`s Motion to Allow Telephonic Testimony of Richard Scheffler rec`d |
| Feb. 09, 1999 | Bon Secours-Venice Hospital, Inc.`s Motion to Allow for Telephone Testimony of Richard Scheffler rec`d |
| Feb. 08, 1999 | Order and Notice of Motion Hearing sent out. (emergency motion for production of witnesses is set for 2/10/99 commencing at 2:00pm by telephone conference) |
| Feb. 08, 1999 | (F. Rainer) Notice of Hearing on Venice`s Motion to Add Witness rec`d |
| Feb. 08, 1999 | (J. Newton) Notice of Hearing (2/10/99; 2:00 p.m.) rec`d |
| Feb. 08, 1999 | CRMC`s Response in Opposition to Venice`s Motion for Protective Order; CRMC`s Notice of February 10 Motion Hearing rec`d |
| Feb. 08, 1999 | cc: Deposition of William Crone ; Naples Community Hospital, Inc.`s Response to Columbia Doctor`s Hospital of Sarasota`s First Set of Interrogatories filed. |
| Feb. 08, 1999 | cc: Deposition of Edward Morton ; Deposition of: William C. Lievense ; Deposition of Michael Jernigan rec`d |
| Feb. 08, 1999 | (J. Newton) Motion for and Memorandum of In Support of Summary Recommended Order of Dismissal and Remand as to Naples Community Hospital, Inc. rec`d |
| Feb. 05, 1999 | (F. Rainer) Motion for Protective Order rec`d |
| Feb. 05, 1999 | (CRMC) Notice of Taking Depositions Duces Tecum filed. |
| Feb. 04, 1999 | (Sarasota Doctors) Emergency Request for Hearing (filed via facsimile). |
| Feb. 04, 1999 | Doctors Hospital`s Emergency Motion to Dismiss Petition of Naples Community Hospital or to Exclude Naples Community Hospital from Introducing Evidence (filed via facsimile). |
| Feb. 03, 1999 | (F. Rainer) Notice of Taking Deposition Duces Tecum filed. |
| Feb. 01, 1999 | (J. Newton) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 27, 1999 | CRMC`s Response in Opposition to Venice`s Motion to Add Witness rec`d |
| Jan. 26, 1999 | Order sent out. (re: motion to compel/due diligence report) |
| Jan. 26, 1999 | (CRMC) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 26, 1999 | (J. Newton) Notice of Taking Deposition Duces Tecum; Amended Notice of Taking Deposition Duces Tecum filed. |
| Jan. 26, 1999 | (CRMC) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 25, 1999 | (K. Putnal) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 25, 1999 | (J. Newton) (3) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 25, 1999 | (K. Putnal) Amended Notice of Taking Depositions Duces Tecum (filed via facsimile). |
| Jan. 25, 1999 | (K. Putnal) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 21, 1999 | Bon Secours-Venice Hospital, Inc.`s Motion to Add Witness rec`d |
| Jan. 21, 1999 | Sarasota Memorial Hospital`s Response and Objection to Venice Hospital`s Motion to Compel Production of Documents in Response to Venice`s Fourth Request to Produce, and Memorial`s Related Motion for Attorneys Fees & Costs filed. |
| Jan. 20, 1999 | (J. Newton) (2) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 19, 1999 | (CRMC) Cross-Notice of Taking Depositions filed. |
| Jan. 19, 1999 | Venice`s Notice of Cancellation of Depositions rec`d |
| Jan. 15, 1999 | Subpoena Duces Tecum (J. Newton); Affidavit of Service filed. |
| Jan. 15, 1999 | Subpoena Duces Tecum (J. Newton); Affidavit of Service filed. |
| Jan. 15, 1999 | (K. Putnal) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 14, 1999 | Venice`s Motion to Compel Sarasota memorial`s Production of Documents in Response to Venice`s Fourth Request for Production of Documents filed. |
| Jan. 14, 1999 | (J. Newton) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 14, 1999 | (J. Newton) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 12, 1999 | Naples Community Hospital, Inc.`s Cross-Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 12, 1999 | Memorial`s Cross Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 12, 1999 | (K. Putnal) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 11, 1999 | Memorial`s Cross-Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 07, 1999 | (CRMC) Cross-Notice of Taking Depositions filed. |
| Jan. 05, 1999 | (CRMC) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 05, 1999 | Naples Community Hospital, Inc.`s Cross Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jan. 04, 1999 | (Sarasota) Amended Notice of Taking Deposition Duces Tecum filed. |
| Jan. 04, 1999 | (Sarasota) Notice of Taking Deposition Duces Tecum filed. |
| Jan. 04, 1999 | Venice`s Reply to CRMC`s Responsive Memorandum of Law Regarding Redacted Portions of Venice`s Due Diligence Report filed. |
| Jan. 04, 1999 | (Sarasota) Second Amended Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Dec. 31, 1998 | Sarasota Memorial Hospital`s Response to Bon Secours-Venice Hospital`s Motion to Compel Response to Venice`s Second Request for Admissions filed. |
| Dec. 30, 1998 | Venice`s First Amended Notice of Taking Deposition Duces Tecum filed. |
| Dec. 30, 1998 | CRMC`s Responsive Memorandum of Law Regarding Redacted Portions of Venice`s Due Diligence Report filed. |
| Dec. 30, 1998 | Venice`s Notice of Cancellation of Depositions filed. |
| Dec. 28, 1998 | (F. Rainer) Memorandum of Law on Privilege Protection for Redacted Portion of Venice Hospital`s Due Diligence Report; Venice Hospital Due Diligence Report (sealed) filed. |
| Dec. 28, 1998 | CRMC`s Reply to Venice`s Response to CRMC`s Motion to Strike/Dismiss Portions of Venice`s Petition for Leave to Intervene filed. |
| Dec. 28, 1998 | (F. Rainer) Memorandum of Law on Privilege Protection for Redacted Portion of Venice Hospital`s Due Diligence Report filed. |
| Dec. 24, 1998 | Venice`s Motion to Compel Sarasota Memorial`s Response to Venice`s Second Request for Admissions or to Deem Matters Admitted filed. |
| Dec. 23, 1998 | Venice`s Response to CRMC`s Motion to Strike/Dismiss Portions of Venice`s Petition for Leave to Intervene filed. |
| Dec. 23, 1998 | (J. Newton) Motion for Extension of Time to Respond to Naples Second Interrogatories; Notice of Taking Deposition Duces Tecum filed. |
| Dec. 23, 1998 | Response of Sarasota Doctors Hospital to the Fourth Request for Production of Documents From Bon Secours-Venice Hospital filed. |
| Dec. 23, 1998 | Response of Sarasota Doctors Hospital to the Second Request for Production of Documents From Naples Community Hospital, Inc. filed. |
| Dec. 22, 1998 | Response of Sarasota Doctors Hospital to the Fourth Request for Production of Documents From Sarasota Memorial Hospital filed. |
| Dec. 22, 1998 | (J. Newton) Amended Notice of Taking Deposition Duces Tecum filed. |
| Dec. 18, 1998 | (Doctors) Motion for Extension of Time (filed via facsimile). |
| Dec. 17, 1998 | (K. Putnal) Amended Notice of Taking Depositions Duces Tecum; Amended Notice of Taking Deposition Duces Tecum filed. |
| Dec. 17, 1998 | Sarasota Memorial Hospital`s Supplemental Response to Bon Secours-Venice Hospital`s Second Request for Admissions filed. |
| Dec. 17, 1998 | CRMC`s Notice of Motion Hearing (filed via facsimile). |
| Dec. 17, 1998 | CRMC`s Reply to Venice`s "Response to CRMC`s Motion to Preclude Venice Witnesses, or, in the Alternative, to Require Venice to Produce Said Witnesses for Deposition." filed. |
| Dec. 17, 1998 | CRMC`s Reply to "Venice`s Response to CRMC`s Motion to Enforce and Require Production of Redacted Portions of Due Diligence Report" filed. |
| Dec. 17, 1998 | CRMC`s Reply to "Venice`s Response to John Goodman Issue by CRMC" filed. |
| Dec. 17, 1998 | Venice`s Motion to Compel Against Sarasota Memorial Hospital and CRMC (Transcript) filed. |
| Dec. 17, 1998 | CRMC`s Written Response to, and Motion to Strike/Dismiss Portions of Venice`s Petition for Leave to Intervene filed. |
| Dec. 17, 1998 | CRMC`s Notice of Motion Hearing (filed via facsimile). |
| Dec. 14, 1998 | Sarasota Memorial Hospital, Inc.`s Notice of Appearance of Co-Counsel (filed via facsimile). |
| Dec. 14, 1998 | CRMC`s Notice of Cancellation of Motion Hearing filed. |
| Dec. 14, 1998 | (J. Newton) Notice of Taking Deposition Duces Tecum filed. |
| Dec. 11, 1998 | CRMC`s Response to Venice`s Objections to December 15 Motion Hearing filed. |
| Dec. 11, 1998 | (CRMC) Notice of Taking Deposition Duces Tecum filed. |
| Dec. 11, 1998 | Naples Community Hospital, Inc.`s Response to Sarasota Doctors` Motion to Compel Answers to Interrogatories (filed via facsimile). |
| Dec. 11, 1998 | Naples Community Hospital, Inc.`s Response to Sarasota Doctors` Motion to Compel Response to Request for Admissions (filed via facsimile). |
| Dec. 11, 1998 | Venice`s Motion to Compel Sarasota Doctors` Response to Venice`s Second Request for Admissions or to Deem Matters Admitted filed. |
| Dec. 11, 1998 | Venice`s Response to CRMC`s Motion to Preclude Venice Witnesses, or, in the Alternative, to Require Venice to Produce Said Witnesses for Deposition filed. |
| Dec. 11, 1998 | Venice`s Response to John Goodman Issue by CRMC; Venice`s Response to CRMC`s Motion to Enforce and Require Production of Redacted Portions of Due Diligence Report filed. |
| Dec. 11, 1998 | Venice`s Objection to CRMC`s Notice of Motion Hearing for December 15, 1998 w/cover letter filed. |
| Dec. 10, 1998 | CRMC`s Emergency Motion for Production of John Goodman in Tallahassee for Deposition, for Other Appropriate Relief, and for Sanctions Against Venice filed. |
| Dec. 10, 1998 | CRMC`s Notice of Motion Hearing (12/15/98; 10:00 a.m.) filed. |
| Dec. 10, 1998 | (Sarasota Doctor`s Hospital) Motion for Extension of Time filed. |
| Dec. 09, 1998 | Venice`s Petition for Leave to Intervene in Administrative Rule Challenge filed. |
| Dec. 09, 1998 | (F. Rainer) Notice of Additional Time to Respond to CRMC`s Motion to Preclude Certain Venice Witnesses filed. |
| Dec. 09, 1998 | Naples Community Hospital, Inc.`s Cross Notice of Taking Deposition Duces Tecum (2) (filed via facsimile). |
| Dec. 09, 1998 | Letter to Judge Maloney from K. Putnal Re: Copying in camera inspection documents filed. |
| Dec. 09, 1998 | (R. Weiss) (2) Notice of Taking Deposition Duces Tecum filed. |
| Dec. 08, 1998 | (CRMC) Supplement to CRMC`s Motion to Enforce November 10 Order Regarding Venice`s Obligation to Produce Responsive Documents to CRMC`s Request to Produce No. 95 filed. |
| Dec. 07, 1998 | CRMC`s Notice of Compliance filed. |
| Dec. 07, 1998 | (F. Rainer) Notice of Taking Deposition Duces Tecum filed. |
| Dec. 07, 1998 | CRMC`s Notice of Compliance filed. |
| Dec. 04, 1998 | Order sent out. (re: rulings from in camera inspection of documents) |
| Dec. 04, 1998 | (Doctors) Motion for Extension of Time filed. |
| Dec. 03, 1998 | CRMC`s Motion to Preclude Venice from Presenting the Testimony of Certain Listed Witnesses, or in the Alternative, Motion to Require Venice to Produce Said Witnesses for Deposition filed. |
| Dec. 03, 1998 | CRMC`s Motion to Enforce November 10 Order Regarding Venice`s Obligation to Produce Responsive Documents to CRMC`s Request to Produce No. 95 filed. |
| Dec. 02, 1998 | Order Compelling Production, In Part and Protective Order, In Part sent out. |
| Dec. 01, 1998 | (Petitioner) Notice of Filing; Subpoena Duces Tecum filed. |
| Nov. 25, 1998 | (2) Naples Community Hospital, Inc.`s Cross-Notice of Taking Deposition Duces Tecum filed. |
| Nov. 25, 1998 | (J. Newton) Motion to Compel Response to Request for Admissions ; Motion to Compel Answers to Interrogatories filed. |
| Nov. 20, 1998 | (R. Weiss) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Nov. 20, 1998 | (R. Weiss) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Nov. 19, 1998 | Naples Community Hospital, Inc.`s Cross-Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Nov. 19, 1998 | (J. Newton) (2) Notice of Taking Deposition Duces Tecum filed. |
| Nov. 19, 1998 | (J. Newton) Notice of Taking Deposition Duces Tecum filed. |
| Nov. 19, 1998 | (Robert Weiss) Amended Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Nov. 18, 1998 | Letter to Judge Maloney from F. Rainer Re: In Camera Inspection of Sarasota Doctors` Documents filed. |
| Nov. 18, 1998 | (Robert Weiss) Notice of Taking Depositions Duces Tecum (filed via facsimile). |
| Nov. 17, 1998 | Venice`s Response to Sarasota Memorial`s Memorandum of Law Regarding Trade Secret Documents filed. |
| Nov. 17, 1998 | CRMC`s Notice of Cancellation of Phil Rond Deposition Scheduled for November 17 filed. |
| Nov. 17, 1998 | (R. Weiss) Notice of Taking Deposition Duces Tecum filed. |
| Nov. 16, 1998 | CRMC`s Notice of Service of Answers to Interrogatories filed. |
| Nov. 13, 1998 | Sarasota Memorial Hospital`s Memoriandum of Law Regarding Trade Secret Documents; Transcript Venice`s Motions to Compel Against Sarasota Memorial Hospital and CRMC ; Documents filed. |
| Nov. 12, 1998 | (J. Newton) Notice of Taking Deposition Duces Tecum filed. |
| Nov. 10, 1998 | Order sent out. (re: rulings from motion hearing regarding discovery issues) |
| Nov. 10, 1998 | (CRMC) 4/Notice of Taking Deposition Duces Tecum filed. |
| Nov. 09, 1998 | Supplemental Pre-Hearing Order sent out. |
| Nov. 09, 1998 | Order Adopting Parties` Stipulation Regarding Documents Produced in Pretrial Discovery sent out. |
| Nov. 09, 1998 | Order sent out. (Ruling on Venice`s Motion to Compel Against Sarasota Memorial) |
| Nov. 09, 1998 | (Naples) Notice of Taking Cross-Deposition Duces Tecum (filed via facsimile). |
| Nov. 09, 1998 | Naples Community Hospital, Inc.`s Amended Cross-Notice of Taking Deposition Duces Tecum (Amended as to Date Only) (filed via facsimile). |
| Nov. 05, 1998 | Venice`s Response to CRMC`s October 30th Motion to Compel filed. |
| Nov. 05, 1998 | CRMC`s Amended WrittenResponse to Venice`s Motion to Compel, and Second Supplemental Responses to Venice`s Discovery Requests filed. |
| Nov. 05, 1998 | CRMC`s Response to Venice`s Second Motion to Compel Against CRMC and Supplemental Responses filed. |
| Nov. 05, 1998 | Affidavit of Kathy Burke inSupport of CRMC`s Oppositon to Venice`s Motion to Compel Against CRMC. filed. |
| Nov. 05, 1998 | CRMC`s Notice of Filing of Affidavit of Kathy Burke in Support of CRMC`s Amended Written Response in Opposition to Venice`s Motion to Compel, and Supplemental Responsesto Venice`s Discovery Requests filed. |
| Nov. 05, 1998 | CRMC`s Supplemental Response to Venice`s First Request for Production of Documents in the Rule Challenge filed. |
| Nov. 04, 1998 | Sarasota Doctor`s Hospital Motion for Protective Order for teh Deposition of Bob Goodman (filed via facsimile). |
| Nov. 03, 1998 | Bon Secours-Venice Hospital`s Fourth Request for Production of Documents to Sarasota Doctors filed. |
| Nov. 03, 1998 | Naples Community Community Hospital, Inc.`s Second Request for Production of Documents to Sarasota Doctors Hospital, Inc. (filed via facsimile). |
| Nov. 03, 1998 | Notice of Service of Intervenor, Naples Community Hospital, Inc. Second Set of Interrogatories to Petitioner, Sarasota Doctors Hospital, Inc. (filed via facsimile). |
| Nov. 03, 1998 | (Robert Weiss) 2/Amended Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Nov. 02, 1998 | (Venic) Notice of Taking Cross Deposition Duces Tecum filed. |
| Oct. 30, 1998 | Venice`s Second Motion to Compel Production of Documents and Responses to Interrogatories by CRMC filed. |
| Oct. 30, 1998 | Bon Secours-Venice Hospital`s Fourth Request for Production of Documents to Sarasota Memorial filed. |
| Oct. 30, 1998 | Notice of Hearing on Venice`s Second Motion to Compel Production of Documents and Responses to Interrogatories by CRMC Dated October 30, 1998 filed. |
| Oct. 30, 1998 | CRMC`s October 30 Motion to Compel Against Venice; CRMC`s Notice for November 6 Motion Hearing filed. |
| Oct. 30, 1998 | Sarasota Doctor`s Hospital`s Response to Second Request for Admissions of Bon Secours-Venice Hospital filed. |
| Oct. 29, 1998 | Third Request of Sarasota Doctor`s Hospital, Inc., d/b/a Columbia Doctor`s Hospital of Sarasota, for Produciton of Documents to Sarasota County Public Hospital Board d/b/a Sarasota Memorial Hospital filed. |
| Oct. 28, 1998 | Notice of Matters for Hearing on Venice`s Motion to Compel Against CRMC filed. |
| Oct. 28, 1998 | Sarasota Memorial Hospital`s Response to Bon Secours-Venice Hospital`s Second Request for Admissions filed. |
| Oct. 26, 1998 | CRMC`s Response in Opposiiton to venice`s Motion for Extension of Time for Expert Witness Opinion Formulation filed. |
| Oct. 26, 1998 | CRMC`s Written Opposition to Joint Motion for Supplemental Prehearing Order filed. |
| Oct. 26, 1998 | Naples Community Hospital, Inc.`s Corss-Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Oct. 23, 1998 | (Bon Secours) Notice of Taking Deposition Duces Tecum filed. |
| Oct. 23, 1998 | (R. Weiss) Notice of Taking Deposition Duces Tecum; Sarasota Memorial`s Response to Venice`s Motion for Extension of Time for Witness Opinion Formulation filed. |
| Oct. 23, 1998 | Sarasota Memorial`s Response to Joint Motion for Supplemental Prehearing Order filed. |
| Oct. 22, 1998 | Joinder in Joint Motion of Sarasota Doctors and Bon Secours for Supplemental Pre-Hearing Order filed. |
| Oct. 21, 1998 | (Bon Secours-Venice Hospital) Notice of Continued Hearing on Venice`s Motions to Compel; Venice`s Response to CRMC`s Fourth Request for Production of Documents filed. |
| Oct. 21, 1998 | (Sarasota Memorial) 2/Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Oct. 20, 1998 | Sarasota Memorial Hospital`s Amended Response to Venice Hospital`s First Request for Production of Documents filed. |
| Oct. 20, 1998 | Joint Motion of Sarasota Doctors and Bon Secours for Supplemental Pre-Hearing Order; Supplemental Pre-Hearing Order; Disk filed. |
| Oct. 19, 1998 | (Doctors) Motion for Extension of Time to Respond to Third Request to Produce from Bon Secours-Venice Hospital (filed via facsimile). |
| Oct. 19, 1998 | Venice`s Response to the Third Request to Produce of Sarasota Doctors Hospital, Inc.; Request for Hearing on Venice`s Motion to Compel Against Sarasota Memorial filed. |
| Oct. 19, 1998 | CRMC`s Response to Venice`s Second Request for Admissions to CRMC filed. |
| Oct. 15, 1998 | (Bon Secours-Venice Healthcare Corp.) Motion for Extension of Time of Expert Witness Opinion Formulation by Venice filed. |
| Oct. 14, 1998 | (J. Newton) Response of Sarasota Doctors` to Naples Community Hospital`s First Request for Production of Documents filed. |
| Oct. 09, 1998 | (G. Sternstein) Notice of Taking Deposition Duces Tecum filed. |
| Oct. 08, 1998 | Amended Notice of Hearing sent out. (hearing reset for Feb. 23 - March 12, 1999; 9:00am; Tallahassee) |
| Oct. 08, 1998 | (K. Putnal) Amended Notice of Taking Deposition Duces Tecum filed. |
| Oct. 08, 1998 | Sarasota Memorial Hospital`s Response to Venice Hospital`s Third Request for Production of Documents filed. |
| Oct. 08, 1998 | (R. Weiss) Notice of Taking Deposition Duces Tecum filed. |
| Oct. 08, 1998 | Naples Community Hospital, Inc.`s Amended Notice of Rule 1.310(b)(6) Depositions Duces Tecum to Sarasota Doctors Hospital (filed via facsimile). |
| Oct. 08, 1998 | (Doctors) Motion for Extension of Time to Respond toThird Request to Produce from Bon Secours-Venice Hospital (filed via facsimile). |
| Oct. 08, 1998 | Letter to J. Newton from W. David Watkins (RE: confirming agreement reached regarding deposition) (filed via facsimile). |
| Oct. 07, 1998 | Letter to Judge Maloney from J. Hauser Re: Dates available for final hearing in February filed. |
| Oct. 07, 1998 | Order sent out. (re: rulings on motions to compel) |
| Oct. 07, 1998 | Order sent out. (parties to file suggested hearing dates by 10/12/98) |
| Oct. 07, 1998 | CRMC`s Objections to "Bon Secours` Initial Interrogatories to CRMC"filed. |
| Oct. 07, 1998 | CRMC`s Written Responses and Legal Objecitons to Bon Secours` Request for Production of Documents to CRMC; CRMC`s Objections and Written Responses to Venice`s Third Request for Production of Documents on CRMC filed. |
| Oct. 06, 1998 | CRMC`s Emergency Motion for Relief and Protective Order from October 8 Deposition (filed via facsimile). |
| Oct. 06, 1998 | CRMC`s Notice of Filing Correspondence; Letter to F. Rainer from J. Hauser Re: District 8 open heart case; Letter to R. Weiss, J. Hauser from F. Rainer Re: Motions to Compel and Corporate Representative Depositions filed. |
| Oct. 06, 1998 | Letter to J. Newton from W. David Watkins (RE: response to memo of 10/5/98) (filed via facsimile). |
| Oct. 06, 1998 | (R. Weiss) Notice of Canceling Deposition (filed via facsimile). |
| Oct. 05, 1998 | Letter to Judge Maloney from J. Newton (RE: enclosing copy of proposal) (filed via facsimile). |
| Oct. 05, 1998 | Notice of Filing Exhibits for Hearing Scheduled for October 5, 1998 at 11:00a.m. on Sarasota Doctor`s Hospital`s Partially Agreed to and Partially Unopposed Motion for Continuanace (filed via facsimile). |
| Oct. 05, 1998 | (Sarasota) Reply to Naples Community Hospital`s Motion to Compel First Request for Production and First Set of Interrogatories (filed via facsimile). |
| Oct. 05, 1998 | (Sarasota) Reply to Bon Secours Venice Hospital`s Motion to Compel Second Request for Production (filed via facsimile). |
| Oct. 02, 1998 | Venice`s Preliminary Witness and Exhibit List filed. |
| Oct. 02, 1998 | Venice`s Response to CRMC`s Motion for Protective Order as to Deposition of Corporate Representative filed. |
| Oct. 02, 1998 | CRMC`s Notice of Filing of Affidavit of Kathleen Kelly in Support of CRMC`s Written Response in Opposition to Venice`s Motion to Compel; Affidavit of Kathleen R. Kelly filed. |
| Oct. 01, 1998 | (J. Newton) Addendum Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Doctor`s Hospital of Sarasota`s Witness & Exhibit List (filed via facsimile). |
| Oct. 01, 1998 | Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Doctor`s Hospital of Sarasota`s Witness & Exhibit List (filed via facsimile). |
| Oct. 01, 1998 | Naples Community Hospital, Inc.`s Witness List; Naples Community Hospital, Inc.`s Exhibit List; Sarasota County Public Hospital Board d/b/a Sarasota Memorial Hospital`s Witness and Exhibit List filed. |
| Oct. 01, 1998 | (Sarasota County Public) Notice of Taking Deposition Duces Tecum filed. |
| Oct. 01, 1998 | CRMC Witness and Exhibit List filed. |
| Oct. 01, 1998 | Letter to Judge Maloney from John Newton (RE: request to reschedule 97-4303) (filed via facsimile). |
| Oct. 01, 1998 | Corrected Sarasota Memorial Hospital`s Response to Venice Hospital`s Motion Compel filed. |
| Sep. 30, 1998 | (Naples) Amended Notice of Hearing (filed via facsimile). |
| Sep. 30, 1998 | Venice`s Response to Sarasota Doctor`s Motion for Continuance filed. |
| Sep. 29, 1998 | (Punta Gorda HMA, Inc.) Notice of Motion Hearing (10/5/98; 11:00 a.m.) filed. |
| Sep. 29, 1998 | CRMC`s Notice of Cancellation of Phil Rond Deposition Scheduled for October 2 filed. |
| Sep. 28, 1998 | Sarasota Memorial Hospial`s Response to Venice Hospital`s Motion to Compel filed. |
| Sep. 28, 1998 | CRMC`s Written Response to Venice`s Motion to Compel, and Supplemental Responses to Venice`s Discovery Requests filed. |
| Sep. 28, 1998 | CRMC`s Motion to Adopt and Accept the Parties` Stipulation Regarding Documents Produced in Pretrial Discovery filed. |
| Sep. 28, 1998 | (John Newton) Notice of Hearing filed. |
| Sep. 25, 1998 | Venice`s Notice of Opposition to Sarasota Doctor`s Motion for Continuance filed. |
| Sep. 25, 1998 | CRMC`s Written Objections to, and Motion for Partial Relief and Protective Order from, Venice`s Amended Notice of Rule 1.310(b)(6) Deposition filed. |
| Sep. 25, 1998 | CRMC`s Response in Opposition to Venice`s Motion to Amend Court`s Order of August 24, 1998 filed. |
| Sep. 24, 1998 | Bon Secours-Venice Hospital`s Second Request for Admissions to Sarasota Doctors filed. |
| Sep. 24, 1998 | Bon Secours-Venice Hospital`s Second Request for Admissions to Punta Gorda HMA; Bon Secours-Venice Hospital`s Second Request for Admissions to Sarasota Memorial filed. |
| Sep. 24, 1998 | Naples Community Hospital, Inc.`s Cross Notice of Rule 1.310(b)(6) Depositions Duces Tecum to Sarasota Doctor`s Hospital (filed via facsimile). |
| Sep. 23, 1998 | Venice`s Motion to Compel Against Sarasota Doctors filed. |
| Sep. 23, 1998 | (Bon Secours) Notice of Motion Hearing filed. |
| Sep. 22, 1998 | Partially Agreed to and Partially Unopposed Motion for Continuance (Petitioners) (filed via facsimile). |
| Sep. 21, 1998 | (F. Rainer) Motion to Amend Court`s Order of August 24, 1998 filed. |
| Sep. 21, 1998 | (Respondent) Notice of Motion Hearing filed. |
| Sep. 18, 1998 | CRMC`s Fourth Request for Production of Documents to Venice filed. |
| Sep. 18, 1998 | Venice`s Amended Notice of Rule 1.310(b)(6) Depositions Duces Tecum to Sarasota Doctor`s Hosptial filed. |
| Sep. 18, 1998 | Venice`s Amended Notice of Rule 1.310(b)(6) Depositions Duces Tecum to CRMC; Venice`s Amended Notice of Rule 1.310(b)(6) Depositions Duces Tecum Sarasota Memorial Hospital filed. |
| Sep. 18, 1998 | Third Request of Sarasota Doctor`s Hospital, Inc., d/b/a Columbia Doctor`s Hospital of Sarasota, for Production of Documents to Bon Secours-Venice Healthcare Corporation filed. |
| Sep. 18, 1998 | CRMC`s Notice of Cancellation of Elfie Stamm Deposition Scheduled for September 18; Amended Notice of Taking Depositions Duces Tecum filed. |
| Sep. 17, 1998 | Order sent out. (Unopposed Motion for Extension of Time for Memorial to respond to Venice`s Motion to Compel is Granted) |
| Sep. 17, 1998 | Amended Order sent out. (Emergency Request for Additional Time to File Response to Venice`s 9/11/98 Motion to Compel is Granted) |
| Sep. 17, 1998 | Naples Community Hospital, Inc.`s Motion to Compel First Request for Production and First Set of Interrogatories From Sarasota Doctor`s Hospital, Inc. filed. |
| Sep. 16, 1998 | Order sent out. (Emergency Request for Additional Time to File Response to Venice`s 9/11/98 Motion to Compel is Granted) |
| Sep. 16, 1998 | (F. Rainer) Notice of Motion Hearing (10/5/98; 2:00 p.m.) filed. |
| Sep. 16, 1998 | (K. Putnal) Unopposed Motion for Extension of Time for Memorial to Respond to Venice`s Motion to Compel filed. |
| Sep. 15, 1998 | (F. Rainer) Response to CRMC`s Emergency Request for Additional Time in Which to File a Written Response to Venice`s September 11 Motion to Compel filed. |
| Sep. 14, 1998 | CRMC`s Emergency Request for Additional Time in Which to File Written Response to Venice`s September 11 Motion to Compel filed. |
| Sep. 11, 1998 | Venice`s Motion to Compel Production of Documents and Responses to Interrogatories by CRMC filed. |
| Sep. 11, 1998 | Venice`s Motion to Compel Production of Documents by Memorial Pursuant to Venice`s First and Second Requests for Production filed. |
| Sep. 09, 1998 | Order sent out. (Motion in Limine is denied; Motion to Compel is granted with instructions to parties) |
| Sep. 09, 1998 | Confidentiality Order sent out. |
| Sep. 08, 1998 | Sarasota Memorial Hospital`s Notice of Serving Third Supplemental Response to Columbia Doctor`s First Set of Interrogatories, Sarasota Memorial`s Third Supplemental Response to Sarasota Doctor`s Hospital, Inc.`s First Set of Interrogatories filed. |
| Sep. 08, 1998 | (CRMC) Notice of Taking Deposition; Notice of Taking Depositions Duces Tecum filed. |
| Sep. 08, 1998 | Notice of Service of Bon Secours` first set of Interrogatories to CRMC, Bon Secours Hospital`s Request for Production of Documents to CRMC filed. |
| Sep. 04, 1998 | (Venice) Response to CRMC`s Motion for Protective Order from Venice`s Notice of Rule 1.310(B)(6) Depositions Duces Tecum filed. |
| Sep. 04, 1998 | CRMC`s Written Responses and Legal Objections to Venice`s Second Request for Production of Documents to CRMC filed. |
| Sep. 04, 1998 | CRMC`s Notice of Filing of Correspondence; Exhibit filed. |
| Sep. 02, 1998 | Bon Secours-Venice Healthcare Corporation`s Amended Privilege Log filed. |
| Sep. 02, 1998 | CRMC`s Objections to and Motion for Protective Order From, Venice`s Notice of Rule 1.310(B)(6) Depositions Duces Tecum (filed via facsimile). |
| Sep. 01, 1998 | Response by Bon Secours-Venice Health Care and St. Joseph`s Hospital, Inc. to CRMC`s Emergency Motion to Enforce Court`s August 24 Order filed. |
| Aug. 31, 1998 | Venice`s Response to CRMC`s Motion to Compel filed. |
| Aug. 31, 1998 | Bon Secours-Venice Health Care Corporation d/b/a Bon Secours-Venice Hospital`s Response to CRMC`s Second Motion in Limine filed. |
| Aug. 28, 1998 | CRMC`s Notice of Motion Hearing (9/2/98; 2:00 p.m.) filed. |
| Aug. 26, 1998 | CRMC`s Request for Motion Hearing filed. |
| Aug. 26, 1998 | CRMC`s Notice of Supplementing Its Motion to Enforce Court`s August 24 Order filed. |
| Aug. 25, 1998 | (James Hauser) Emergency Motion to Enforce Court`s August 24 Order filed. |
| Aug. 25, 1998 | Transcript Hearing on Pending Motions filed. |
| Aug. 25, 1998 | Letter to Judge Maloney from Gerald Sternstein (RE: objects to proposed stipulated Order regarding documents to be produced by Dentry Harrington Herbek and Hebert) (filed via facsimile). |
| Aug. 24, 1998 | Letter to Judge Maloney from G. Sternstein Re: Response to August 18 from CRMC Counsel filed. |
| Aug. 24, 1998 | Order sent out. (Motion to Compel is granted) |
| Aug. 24, 1998 | (3) Venice`s Notice of Rule 1.310(b)(6) Depositions Duces Tecum filed. |
| Aug. 24, 1998 | CRMC`s Motion to Compel Against Venice Regarding CRMC`s Second and Third Request for Production of Documents filed. |
| Aug. 21, 1998 | (Bon Secours) Objections to Document Requests Relating to Notice of Taking Deposition Duces Tecum filed. |
| Aug. 21, 1998 | (CRMC) (2) Notice of Taking Depositions Duces Tecum filed. |
| Aug. 21, 1998 | Notice of Agreement as to Venice`s Second Request for Production of Documents on CRMC filed. |
| Aug. 20, 1998 | (J. Newton) Notice of Telephone Conference Hearing filed. |
| Aug. 20, 1998 | Order sent out. (Re: Rulings on Naples Community Motion for Protective Order) |
| Aug. 20, 1998 | CRMC`s Response and Objections to Venice`s Privilege Log and Proposed Confidentiality Order filed. |
| Aug. 20, 1998 | Sarasota Memorial`s Response to CRMC`s Motion in Limine filed. |
| Aug. 20, 1998 | CRMC`s Notice of Rule 1.310(b)(6) Depositions Duces Tecum; CRMC`s Amended Notice of Rule 1.310(b)(6) Depositions Duces Tecum filed. |
| Aug. 19, 1998 | (Petitioner) Notice of Filing Exhibits for Hearing Scheduled to be Held August 19, 1998 at 2:00 P.M. on Naples Community Hospital`s Motion for Protective Order filed. |
| Aug. 19, 1998 | Bon Secours-Venice Healthcare Corporation`s Privilege Log filed. |
| Aug. 18, 1998 | (CRMC) Motion in Limine; Notice of Taking Depositions Duces Tecum filed. |
| Aug. 18, 1998 | Stipulated Order Regarding Documents to be Produced by Dentry, Harrington, Herbek and Herbert at Their September 9-10 Depositions; Disk w/cover letter filed. |
| Aug. 17, 1998 | Order and Amended Notice of Hearing sent out. (hearing set for Nov. 23 - Dec. 14, 1998, excluding holiday; 98-1134, 98-1142, 98-1145, 98-1497 & 98-3420RX consolidated) |
| Aug. 13, 1998 | Notice of Service of Sarasota Memorial Hospital`s Second Supplemental Response to Sarasota Doctor`s Hospital, Inc.`s First Set of Interrogatories filed. |
| Aug. 13, 1998 | CRMC`s Notice of Witness Fee Payment to Paul McCall filed. |
| Aug. 12, 1998 | Bon Secours-Venice Hospital`s Opposition to CRMC`s Motion to Consolidate filed. |
| Aug. 12, 1998 | (G. Sternstein) Response by Bon Secours-Venice Healthcare Corporation to the Third Request for Production by CRMC filed. |
| Aug. 12, 1998 | (Putna Gorda HMA, Inc.) Notice of Motion Hearing; CRMC`s Motion to Compel Venice to Produce Persons for Deposition and Motion to Compel Production of Deposition Documents filed. |
| Aug. 12, 1998 | (F. Rainer) Notice of Invalid Service of Subpoena on Paul McCall filed. |
| Aug. 12, 1998 | Bon Secours-Venice Health Care Corporation d/b/a Bon Secours-Venice Hospital`s Response to CRMC`s Motion in Limine filed. |
| Aug. 10, 1998 | CRMC`s Notice of Cancellation of Tim Dentry Deposition Scheduled for August 11 filed. |
| Aug. 08, 1998 | Bon Secours Hospital`s Request for Production of Documents to CRMC filed. |
| Aug. 08, 1998 | Notice of Service of Bon Secours` first set of Interrogatories to CRMC filed. |
| Aug. 06, 1998 | Naples Community Hospital, Inc.`s Motion for Protective Order (filed via facsimile). |
| Aug. 06, 1998 | Naples Community Hospital, Inc.`s Notice of Service of Answers to Columbia Doctors`s Hospital of Sarasota`s First Set of Interrogatories (filed via facsimile). |
| Aug. 06, 1998 | (Sarasota) Notice of Hearing filed. |
| Aug. 05, 1998 | Response by Bon Secours-Venice Healthcare Corporation to the First and Second Request for Production by Sarasota Doctor`s Hospital, Inc. filed. |
| Aug. 04, 1998 | Memorial`s Joinder in CRMC`s Motion in Limine (filed via facsimile). |
| Aug. 03, 1998 | Naples Community Hospital, Inc.`s Responses to Columbia`s First Request for Production of Documents filed. |
| Aug. 03, 1998 | Naples Community Hospital, Inc.`s Response to First Request of Sarasota Doctors Hospital, Inc. d/b/a Columbia Doctor`s Hospital of Sarasota, for Production of Documents filed. |
| Jul. 31, 1998 | CRMC`s Motion in Limine filed. |
| Jul. 31, 1998 | CRMC`s Motion to Consolidate (Cases requested to be consolidated: 98-1134, 98-1142, 98-1145, 98-1497) filed. |
| Jul. 31, 1998 | Notice of Service of Sarasota Memorial Hospital`s Supplemental Response to Sarasota Doctor`s Hospital, Inc.`s First Set of Interrogatories (filed via facsimile). |
| Jul. 31, 1998 | (Punta Gorda) Notice of Motion Hearing filed. |
| Jul. 29, 1998 | Bon Secours Venice Hospital`s Second Request for Production of Documents to Sarasota Doctors filed. |
| Jul. 29, 1998 | Bon Secours-Venice Hospital`s Second Request for Production of Documents to Sarasota Memorial filed. |
| Jul. 29, 1998 | Venice`s Response to CRMC`s Second Request for Production of Documents; Bon Secours-Venice Hospital`s Second Request for Production of Documents to CRMC filed. |
| Jul. 29, 1998 | Venice`s Response to Sarasota Doctors` Request for Admissions filed. |
| Jul. 28, 1998 | (F. Rainer) Objections to Document Requests and Motion for a Protective Order filed. |
| Jul. 28, 1998 | Notice of Service of Sarasota Memorial Hospital`s Response to Sarasota Doctor`s Hospital, Inc.`s First Set of Interrogatories and First and Second Request for Production of Documents (filed via facsimile). |
| Jul. 27, 1998 | (Punta Gorda HMA) Notice of Related Case filed. (for 98-1134, 98-1142, 98-1145 & 98-3420RX) |
| Jul. 27, 1998 | (Venice) Supplemental Response to: (1) HMA`s First Request for Production of Documents to Venice, (2) Sarasota Memorial Hospital`s First Request for Production of Documents to Venice etc. filed. |
| Jul. 27, 1998 | (J. Newton) Response to Bon Secours-Venice Healthcare Corporation`s First Request for Production to Columbia Doctor`s Hospital filed. |
| Jul. 24, 1998 | (Punta Gorda HMA, Inc.) Notice of Cancellation of Depositions filed. |
| Jul. 24, 1998 | Transcript filed. |
| Jul. 22, 1998 | Order sent out. (Re: Ruling of Pending Motions; CRMC`s Motion to Compel is Granted) |
| Jul. 21, 1998 | Motion of Sarasota Doctors Hospital, Inc., to Extend Time for Responding to First Request to Produce, Interrogatories and Requests for Admissions to Bon Secours-Venice Healthcare Corporation (filed via facsimile). |
| Jul. 20, 1998 | (J. Newton) Notice of Taking Deposition Duces Tecum (filed via facsimile). |
| Jul. 20, 1998 | CRMC`s Notice of Filing of Supplemental Documents in Support of CRMC`s Motion to Compel Against Venice filed. |
| Jul. 20, 1998 | CRMC`s Response in Opposition to Venice`s Motion for Protective Order filed. |
| Jul. 20, 1998 | CRMC`s Notice of Filing Venice`s Interrogatory Answers; Exhibit "A" filed. |
| Jul. 20, 1998 | (Punta Gorda HMA, Inc.) Notice of Filing; (4) Invoice; (4) Affidavit of Service; (4) Subpoena Duces Tecum filed. |
| Jul. 17, 1998 | (F. Rainer) Amended Motion for a Protective Order filed. |
| Jul. 17, 1998 | (Bon Secours) Amended Notice of Motion Hearing filed. |
| Jul. 16, 1998 | Amended Notice of Hearing, Order and Order Amending Order of Prehearing Instructions sent out. (hearing set for Nov. 30 & Dec. 1-14, 1998; 9:00am; Tallahassee) |
| Jul. 16, 1998 | CRMC`s Response to Bon Secours` and St. Joseph`s Objections to Subpoenas and Notices of Depositions Duces Tecum, and Motion to Compel Attendance of Deponents and Production of Documents filed. |
| Jul. 16, 1998 | CRMC`s Amended Notice of Motion Hearing filed. |
| Jul. 16, 1998 | Letter to R. Weiss from F. Rainer Re: Extension of Time to Submit Verified Interrogatory Answers to Sarasota Memorial filed. |
| Jul. 16, 1998 | CRMC`s Notice of Motion Hearing filed. |
| Jul. 15, 1998 | Bon Secours-Venice Health Care Corporation d/b/a Bon Secours-Venice Hospital`s Response to Sarasota Memorial Hospital`s Second Request for Production of Documents filed. |
| Jul. 15, 1998 | Bon Secours-Venice Health Care Corporation d/b/a Bon Secours-Venice Hospital`s Objections to Sarasota Memorial`s Second Set of Interrogatories filed. |
| Jul. 15, 1998 | (Respondent) Notice of Motion Hearing filed. |
| Jul. 14, 1998 | Notice of Service of Sarasota Memorial Hospital`s Supplemental Response to Bon Secours-Venice Hospital`s Corporation`s First Set of Interrogatories filed. |
| Jul. 14, 1998 | Notice of Service of Sarasota Memorial Hospital`s Responses to Bon Secours-Venice Heathcare Corporation`s First Set of Interrogatories, First Request for Production of Documents, and First Request for Admissions filed. |
| Jul. 14, 1998 | Bon Secours` Response to HMA`s Amended Motion to Compel filed. |
| Jul. 13, 1998 | Letter to Judge Maloney from J. Newton (RE: Notice of unavailability) (filed via facsimile). |
| Jul. 13, 1998 | CRMC`s Response to Venice`s Motion for Pre-Hearing Procedure to Schedule, Limit, and Coordinate Discovery Requests filed. |
| Jul. 13, 1998 | Sarasota Memorial`s Response to Bon Secours-Venice Hospital`s Motion for Pre-Hearing Procedure filed. |
| Jul. 13, 1998 | Bon Secours`, St. Joseph`s and Mr. Michael Harrington`s Motion for a Protective Order filed. |
| Jul. 13, 1998 | CRMC`s Third Request for Production of Documents to Venice filed. |
| Jul. 13, 1998 | Sarasota Doctor`s Hospital`s Response to First Request for Admissions of Bon Secours-Venice Hospital filed. |
| Jul. 13, 1998 | Response of Sarasota Doctors Hospital, Inc., d/b/a filed. |
| Jul. 13, 1998 | (Bon Secour) Notice of Motion Hearing filed. |
| Jul. 13, 1998 | (Punta Gorda) Amended Notice of Motion Hearing (filed via facsimile). |
| Jul. 10, 1998 | Sarasota Memorial`s Addendum to Motion to Compel Bon Secours-Venice Hospital`s Response to Sarasota Memorial Hospital`s First Set of Interrogatories and First Request to Produce filed. |
| Jul. 10, 1998 | CRMC`s Notice of Service of Answers to Venice`s Second Set of Interrogatories; CRMC`s Notice of Service of Supplemental Answers to Venice`s First Set of Interrogatories filed. |
| Jul. 09, 1998 | Naples Community Hospital Inc.`s First Request for Production of Documents to Sarasota Documents Hospital, Inc. (filed via facsimile). |
| Jul. 09, 1998 | Notice of Service of Intervenor, Naples Community Hospital, Inc., First Set of Interrogatories to Petitioner, Sarasota Doctors Hospital, Inc. (filed via facsimile). |
| Jul. 09, 1998 | Bon Secours` and St. Joseph`s Objections to Subpoenas and Notice of Depositions Duces Tecum filed. |
| Jul. 08, 1998 | Bon Secours` Response in Opposition to Memorial`s Motion to Compel filed. |
| Jul. 08, 1998 | (Bon Secours-Venice Hospital) Concurrence of Naples Community Hospital in Motion for Prehearing Procedure for Discovery filed. |
| Jul. 08, 1998 | (Punta Gorda, Inc.) Reconfirmation of Notice of Taking Deposition Duces Tecum of Michael Harrington; CRMC`s Notice to Confirm Location and Status of McCall and Ashe Deposition Exhibits filed. |
| Jul. 08, 1998 | (Petitioner) Notice of Motion Hearing filed. |
| Jul. 08, 1998 | Second Request of Sarasota Doctor`s Hospital, Inc., d/b/a Columbia Doctor`s Hospital of Sarasota, for Production of documents to Bon Secours-Venice Health Care Corporation, d/b/a Bon Secours-Venice Hospital filed. |
| Jul. 07, 1998 | (Putna Gorda HMA, Inc.) Amended Motion to Compel filed. |
| Jul. 07, 1998 | (Putna Gorda HMA, Inc.) Request for Oral Argument filed. |
| Jul. 07, 1998 | (Punta Gorda HMA, Inc.) Amended Notice of Taking Depositions Duces Tecum filed. |
| Jul. 07, 1998 | Motion of Sarasota Doctors Hospital, Inc., to Extend Time for Responding to First Request to Produce, Interrogatories and Requests for Admissions to Bon Secours-Venice Healthcare Corporation filed. |
| Jul. 06, 1998 | Sarasota Memorial Hospital`s Response to Venice Hospital`s First Request for Admissions filed. |
| Jul. 02, 1998 | (Bon Secours) Motion for Prehearing Procedure to Schedule, Limit and Coordinate Discovery Requests filed. |
| Jul. 02, 1998 | (Bon Secours) Notice of Extension of Time to Respond to Motion to Compel filed. |
| Jul. 02, 1998 | Agreed-to Notice of Continuation of Paul McCall Deposition Duces Tecum and Agreed-to Notice of Rescheduling of Duane Ash Deposition Duces Tecum filed. |
| Jul. 02, 1998 | CRMC`s Response to Venice`s Second Set of Interrogatories filed. |
| Jul. 01, 1998 | (2) Verified Return of Service; (2) Subpoena Duces Tecum (J. Hauser); Motion to Compel filed. |
| Jul. 01, 1998 | CRMC`s Supplemental Response to Venice`s First Request for Production of Documents; (2) Notice of Filing; Affidavit of Kathie Talarico; Subpoena Duces Tecum (J. Hauser) filed. |
| Jun. 30, 1998 | Sarasota Doctors Hospital, Inc.`s Notice of Service of First Interrogatories to Naples Community Hospital filed. |
| Jun. 30, 1998 | Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Sarasota Doctor`s Hospital`s Request for Admissions to Sarasota County Public Hospital Board, d/b/a Sarasota Memorial Hospital filed. |
| Jun. 30, 1998 | Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Sarasota Doctor`s Hospital`s Request for Admissions to Bon Secours-Venice Health Care Corporation, d/b/a Bon Secours-Venice Hospital filed. |
| Jun. 29, 1998 | CRMC`s Second Request for Production of Documents to Venice filed. |
| Jun. 29, 1998 | (K. Putnal) Motion to Compel Bon Secours-Venice Hospital`s Response to Sarasota Memorial Hospital`s First Set of Interrogatories and First Request to Produce filed. |
| Jun. 29, 1998 | (Punta Gorda HMA, Inc.) Notice of Taking Deposition Duces Tecum filed. |
| Jun. 29, 1998 | Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Sarasota Doctor`s Hospital`s Request for Admissions to Naples Community Hospital, Intervenor filed. |
| Jun. 26, 1998 | First Request of Sarasota Doctor`s Hospital, Inc., d/b/a Columbia Doctor`s Hospital of Sarasota, for Production of Documents to Naples Community Hospital, Intervenor filed. |
| Jun. 26, 1998 | (J. Newton) Certificate of Service of Interrogatories filed. |
| Jun. 26, 1998 | Sarasota Doctors Hospital, Inc.`s Notice of Service of First Interrogatories to Bon Secours Venice Healthcare Corporation filed. |
| Jun. 24, 1998 | First Request of Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Doctor`s Hospital of Sarasota, for Production of Documents to Punta Gorda HMA, Inc., Licensee for Charlotte Regional Medical Center filed. |
| Jun. 24, 1998 | First Request of Sarasota Doctor`s Hospital, Inc., d/b/a Columbia Doctor`s Hospital of Sarasota, for Production of Documents to Bon Secours-Venice Health Care Corporation, d/b/a Bon Secours-Venice Hospital filed. |
| Jun. 24, 1998 | Response to Sarasota Memorial Hospital`s First Request for Production to Columbia Doctor`s Hospital filed. |
| Jun. 24, 1998 | (J. Newton) Second Request of Sarasota Doctor`s Hospital, Inc. d/b/a Columbia Doctor`s of Sarasota, for Production of Documents to Sarasota County Public Hospital Board, d/b/a Sarasota Memorial Hospital filed. |
| Jun. 23, 1998 | (Petitioner) Notice of Taking Deposition Duces Tecum filed. |
| Jun. 23, 1998 | Sarasota Memorial Hospital`s Response to Sarasota Doctors` Privilege Objections and Motion for Protective Order filed. |
| Jun. 22, 1998 | Notice of Serving Interrogatory Answers by Bon Secours-Venice Healthcare Corporation to Sarasota Memorial Hospital filed. |
| Jun. 22, 1998 | CRMC`s Response to Bon Secours` Request for Admissions filed. |
| Jun. 22, 1998 | Certificate of Service of Punta Gorda HMA, Inc. Answer to Interrogatories From Bon Secours-Venice Health Care Corporation d/b/a Bon Secours-Venice Hospital filed. |
| Jun. 19, 1998 | Response by Bon Secours-Venice Health Care Corporation to the First Request to Produce of Intervenor, Sarasota Memorial Hospital filed. |
| Jun. 17, 1998 | Sarasota Doctors Hospital, Inc.`s Notice of Service of Answers to First Interrogatories of Sarasota Memorial Hospital filed. |
| Jun. 16, 1998 | (J. Newton) Response to Sarasota Memorial Hospital`s First Request for Production to Columbia Doctor`s Hospital filed. |
| Jun. 16, 1998 | Sarasota Doctors` Privilege Objection for Certain Documents Requested in Requests 23, 21, & 32 of Sarasota Memorial`s First Request to Produce to Sarasota Doctors (SEALED FOR IN-CAMERA INSPECTION ONLY) filed. |
| Jun. 16, 1998 | Sarasota Memorial Hospital`s Notice of Service of Second Set of Interrogatories and Second Request for Production of Documents to Venice Hospital (filed via facsimile). |
| Jun. 12, 1998 | First Request for Production to Sarasota County Public Hospital Board d/b/a Sarasota Memorial Hospital From Columbia Doctor`s Hospital of Sarasota filed. |
| Jun. 11, 1998 | Order sent out. (re: rulings regarding discovery) |
| Jun. 10, 1998 | Sarasota Memorial Hospital`s Response and Objection to Columbia Doctor`s Hospital`s Motion to Assert Untimely Objections to Discovery filed. |
| Jun. 09, 1998 | Doctor`s Hospital`s Motion for Extension of Time to Respond to First Interrogatories and Request to Produce of Sarasota Memorial (filed via facsimile). |
| Jun. 04, 1998 | Bon Secours-Venice Hospital`s Notice of Withdrawal of Request for Admissions to Naples Community Hospital, Inc. filed. |
| Jun. 02, 1998 | Order Granting Petition to Intervene (Naples Community Hospital, Inc.) sent out. |
| Jun. 02, 1998 | Notice of Service of Bon Secours` Second Set of Interrogatories to Punta Gorda HMA, Inc. filed. |
| May 21, 1998 | Notice of Service of Bon Secours` First Set of Interrogatories to Sarasota Doctors Hospital; Bon Secours-Venice Hospital`s Request for Admissions to Sarasota Doctors filed. |
| May 21, 1998 | Bon Secours-Venice Hospital`s Request for Admissions to Sarasota Memorial; Bon Secours-Venice Hospital`s First Request for Production of Documents to Sarasota Doctors filed. |
| May 21, 1998 | Bon Secours-Venice Hospital`s First Request for Production of Documents to Sarasota Memorial; Notice of Service of Bon Secours` First Set of Interrogatories to Sarasota Memorial filed. |
| May 21, 1998 | Bon Secours-Venice Hospital`s Request for Admissions to Naples Community Hospital, Inc.; Bon Secours-Venice Hospital`s Request for Admissions to Punta Gorda HMA filed. |
| May 10, 1998 | Bon Secours Response to HMA`s First Request for Production of Documents filed. |
| May 08, 1998 | Sarasota Memorial Hospital`s Notice of Service of Second Set of Interrogatories to Columbia Doctor`s Hospital filed. |
| May 01, 1998 | Sarasota Memorial Hospital`s Notice of Service of Interrogatories to Bon Secours-Venice Healthcare Corporation d/b/a Bon Secours-Venice Hospital filed. |
| May 01, 1998 | Sarasota Memorial Hospital`s Notice of Service of First Set of Interrogatories to Columbia Doctor`s Hospital filed. |
| May 01, 1998 | CRMC`s Written Response and Legal Objections to Written Discovery Requests Served by Venice Hospital filed. |
| Apr. 30, 1998 | (Naples) Petition to Intervene filed. |
| Mar. 26, 1998 | Order of Consolidation and Notice of Hearing sent out. (98-1134, 98-1142, 98-1145 & 98-1497 are consolidated; hearing set for Oct. 8-22, 1998; 9:00am; Tallahassee) (CN002902) |
| Mar. 26, 1998 | Order sent out. (Motions filed 3/24/98 are denied) |
| Mar. 26, 1998 | Notice of Hearing sent out. (hearing set for Oct. 8-22, 1998; 9:00am; Tallahassee) |
| Mar. 24, 1998 | Sarasota County Public Hospital Board d/b/a Sarasota Memorial Hospital Response to Bon Secours-Venice Healthcare Corporation`s Motion to Dismiss and/or Strike Portions of Sarasota County`s Petition for Formal Administrative Proceeding filed. |
| Mar. 24, 1998 | HMA`s Response in Opposition to Venice`s Motion to Dismiss and/or Motion to Strike Portions of HMA`s Petitioner for Formal Administrative Hearing; (Punta Gorda) Response to Prehearing Order filed. |
| Mar. 20, 1998 | (AHCA) Notice of Related Petitions filed. (for DOAH #`s 98-1134, 98-1142, 98-1145 & 98-1497) |
| Mar. 18, 1998 | (Gerald Sternstein) Notice of Appearance filed. |
| Mar. 17, 1998 | Prehearing Order and Order of Consolidation sent out. (Consolidated cases are: 98-1134, 98-1142 & 98-1145) . CONSOLIDATED CASE NO - CN002902 |
| Mar. 16, 1998 | HMA`s Motion to Consolidate filed. |
| Mar. 13, 1998 | (Bon Secours-Venice Health Care) Notice of Filing Omitted Exhibit; Exhibit filed. |
| Issue Date | Document | Summary |
|---|---|---|
| Feb. 10, 2000 | Agency Final Order | |
| Sep. 16, 1999 | Recommended Order | First two sentences of Rule 59C-1.033(7)(c), FAC, are invalid. Certificate of Need applications of Sarasota and Venice should be denied: Sarasota`s - quality of care issues; Venice`s - it will drop Charlotte`s annual open heart surgery value below 350. |
